6/21/2022
a pregnancy where the gestation exceeds 42
completed weeks (294 days).
Simpson and Stanley 2011). Gülmezoglu et al
(2012) refer to pregnancies that go beyond 294 days
as both post-term and postdate.
PROLONGED PREGNANCY
R. NDERITU
the term prolonged pregnancy will be used to describe Simpson and Stanley (2011) suggest that if a
a pregnancy equal to or beyond 42 weeks. pregnancy continues beyond 41 completed weeks the
risks for the mother are associated with a large for
Postmaturity refers to a description of the neonate gestational age or macrosomic infant such as shoulder
with dystocia, genital tract trauma, operative birth and
postpartum haemorrhage (PPH).
peeling of the epidermis,
In an otherwise low-risk pregnancy such risks must
long nails,
loose skin suggestive of recent weight loss and
be balanced with the risks of IOL, such as
increased need for epidural anaesthesia, uterine
an alert face (Koklanaris and Tropper 2006).
hyperstimulation, operative birth, PPH and failed
induction.
1
, 6/21/2022
risks for the fetus and neonate in a prolonged conversely the cases where growth continues
pregnancy appear to be two-fold: =====macrosomic infant at risk of
bony injury, soft tissue trauma,
placental dysfunction linked to
hypoxia and
oligohydramnios
restricted fetal growth
cerebral haemorrhage.
meconium aspiration
asphyxia and
still birth
PLAN OF CARE FOR PROLONGED PREGNANCY
PREDISPOSING FACTORS
obesity The concept of ‘plan of care’ for prolonged pregnancy
nulliparity is perhaps less autocratic, the term implying an
family history of prolonged pregnancy approach the purpose of which is for the healthcare
male fetus, professional to work with the woman to determine
fetal anomaly such as anencephaly the most appropriate way forward with the pregnancy
in order to ensure the optimum outcome for both
Cardozo et al (1986) suggest there might be three sub- mother and baby.
groups related to a prolonged pregnancy, which include
those where
the dates are incorrect, those with a
normal prolonged gestation where physiological maturity is
achieved after 42 weeks and those
with correct dates and are functionally mature but who do
not go into labour at term.
2
, 6/21/2022
CERVICAL MEMBRANE SWEEP
In a prolonged pregnancy where there are any obstetric or (CMS) at 41 weeks’ gestation has been shown to
medical complications the priority in the plan of care should, increase the spontaneous onset of labour before 42 weeks
with maternal consent, follow the practice for the specific in some nulliparous and parous women
complication.
The purpose of CMS is to attempt to initiate the onset
If the pregnancy is otherwise low risk, the plan of care can of labour physiologically thus avoiding the intervention of
follow an expectant or active approach, and the decision on
which approach to take should be based on the woman (and IOL using prostaglandin, artificial rupture of membranes
partner) receiving the information on the possible benefits (ARM) and oxytocin.
and risks of each to enable her to make an informed decision CMS is designed to separate the membranes from their
based on informed choice. cervical attachment by introducing the examining fingers
If a woman chooses the expectant approach the into the cervical os and passing them
recommendations from NICE (2008a) are increased antenatal circumferentially around the cervix.
surveillance which includes cardiotocography (CTG) at least The process of detaching the membranes from the decidua
two times a week, and an ultrasound scan to estimate the
maximum amniotic fluid pool depth rather than a more complex results in an increase in the concentration of circulating
approach to antenatal fetal surveillance which includes prostaglandins = initiation of the onset of labour in some
‘computerised CTG, amniotic fluid index, and assessment of fetal individuals (Mitchell et al 1977).
breathing, tone and gross body movements’ (NICE 2008a: 279).
Massage of the cervix can be used
when the cervical os remains closed and this process
cause release of local prostaglandin.
If after an appropriate time labour has not started
spontaneously the process can be repeated.
The practice of CMS is not associated with any
increase in maternal or neonatal infection although
women report more vaginal blood loss and painful
contractions in the 24-hour period following the
procedure.
3
a pregnancy where the gestation exceeds 42
completed weeks (294 days).
Simpson and Stanley 2011). Gülmezoglu et al
(2012) refer to pregnancies that go beyond 294 days
as both post-term and postdate.
PROLONGED PREGNANCY
R. NDERITU
the term prolonged pregnancy will be used to describe Simpson and Stanley (2011) suggest that if a
a pregnancy equal to or beyond 42 weeks. pregnancy continues beyond 41 completed weeks the
risks for the mother are associated with a large for
Postmaturity refers to a description of the neonate gestational age or macrosomic infant such as shoulder
with dystocia, genital tract trauma, operative birth and
postpartum haemorrhage (PPH).
peeling of the epidermis,
In an otherwise low-risk pregnancy such risks must
long nails,
loose skin suggestive of recent weight loss and
be balanced with the risks of IOL, such as
increased need for epidural anaesthesia, uterine
an alert face (Koklanaris and Tropper 2006).
hyperstimulation, operative birth, PPH and failed
induction.
1
, 6/21/2022
risks for the fetus and neonate in a prolonged conversely the cases where growth continues
pregnancy appear to be two-fold: =====macrosomic infant at risk of
bony injury, soft tissue trauma,
placental dysfunction linked to
hypoxia and
oligohydramnios
restricted fetal growth
cerebral haemorrhage.
meconium aspiration
asphyxia and
still birth
PLAN OF CARE FOR PROLONGED PREGNANCY
PREDISPOSING FACTORS
obesity The concept of ‘plan of care’ for prolonged pregnancy
nulliparity is perhaps less autocratic, the term implying an
family history of prolonged pregnancy approach the purpose of which is for the healthcare
male fetus, professional to work with the woman to determine
fetal anomaly such as anencephaly the most appropriate way forward with the pregnancy
in order to ensure the optimum outcome for both
Cardozo et al (1986) suggest there might be three sub- mother and baby.
groups related to a prolonged pregnancy, which include
those where
the dates are incorrect, those with a
normal prolonged gestation where physiological maturity is
achieved after 42 weeks and those
with correct dates and are functionally mature but who do
not go into labour at term.
2
, 6/21/2022
CERVICAL MEMBRANE SWEEP
In a prolonged pregnancy where there are any obstetric or (CMS) at 41 weeks’ gestation has been shown to
medical complications the priority in the plan of care should, increase the spontaneous onset of labour before 42 weeks
with maternal consent, follow the practice for the specific in some nulliparous and parous women
complication.
The purpose of CMS is to attempt to initiate the onset
If the pregnancy is otherwise low risk, the plan of care can of labour physiologically thus avoiding the intervention of
follow an expectant or active approach, and the decision on
which approach to take should be based on the woman (and IOL using prostaglandin, artificial rupture of membranes
partner) receiving the information on the possible benefits (ARM) and oxytocin.
and risks of each to enable her to make an informed decision CMS is designed to separate the membranes from their
based on informed choice. cervical attachment by introducing the examining fingers
If a woman chooses the expectant approach the into the cervical os and passing them
recommendations from NICE (2008a) are increased antenatal circumferentially around the cervix.
surveillance which includes cardiotocography (CTG) at least The process of detaching the membranes from the decidua
two times a week, and an ultrasound scan to estimate the
maximum amniotic fluid pool depth rather than a more complex results in an increase in the concentration of circulating
approach to antenatal fetal surveillance which includes prostaglandins = initiation of the onset of labour in some
‘computerised CTG, amniotic fluid index, and assessment of fetal individuals (Mitchell et al 1977).
breathing, tone and gross body movements’ (NICE 2008a: 279).
Massage of the cervix can be used
when the cervical os remains closed and this process
cause release of local prostaglandin.
If after an appropriate time labour has not started
spontaneously the process can be repeated.
The practice of CMS is not associated with any
increase in maternal or neonatal infection although
women report more vaginal blood loss and painful
contractions in the 24-hour period following the
procedure.
3
