PROLONGED PREGNANCY

2011
Dr K Waqanisau
O&G Dept
CWM Hospital

Introduction
Prolonged pregnancy
longer than 42 weeks /

Perinatal
Perinatal outcome
outcome

294 days from LNMP*

Post Datism
lasting beyond the EDD

(40 weeks)
5 10% of all pregnancy will

Prevention
Prevention of
of post
post date
date
Induction
Induction vs
vs Expectant
Expectant

continue to at least 42 weeks

Fetal
Fetal Surveillance
Surveillance
Summary
Summary
* WHO Definition

PERINATAL OUTCOME

Relation to gestational age

Relation to gestational age

Perinatal mortality Rate

40 weeks = 2 -3 per 1000
42 Weeks = x 2
44 Weeks = x 4 - 6

Hollis B. Prolonged pregnancy. Curr

Opin Obstet Gynecol 2002;14:203-7.

PREVENTION OF POST DATE

Dating
Dating

Reduc
Reduc
ee PD
PD
Nipple
Nipple

Sweepi
Sweepi
ng
ng

Accurate Dating
USScan
CRL = 8 13 weeks +/- 5 days*
Biparietal diameter (BPD) = 12-20 weeks +/-

1 week,
BPD at 20-30 weeks +/- 2 weeks
BPD after 30 weeks +/-

3 weeks

Transcerebellar Diameter
The diameter in millimeters corresponds to weeks of
gestation up to 24 weeks.

The scan is more accurate if 2 or more

parameters^
* - ALSO course syllabus 2000

2001

Sweeping Membrane
Theoretical Risks

Benefits

1. PROM

10% will achive labour

2. APH

in 7 hrs *
Decr synto
More NVD
Decr PT

3. Chorioamnionitis

Effective
. Nulliprious

Women
. Low Bishop Score

No trial on 1x or multiple
Most women find it very painful

^
NNT is 8 to avoid 1 IOL ^

- * McColgin SW, Parturitional factors associated with membrane

stripping. Am J Obstet Gynecol 1993;169:717.
^ de Miranda E Membrane sweeping and prevention of post-term
pregnancy in low-risk pregnancies: a randomized controlled trial.

Nipple stimulation

No evidence

INDUCTION VS EXPECTANT

Evidence
There was only 19 trials from RCT from

1969 2005
The Canadian multicentre post term
pregnancy 1992
They were all under powered in detecting
perinatal outcome

Canadian multicentre post term

pregnancy (CMPPT)
Enrolled 3407
Focused on IOL @ 41 weeks and expectant till 44

weeks or Obstetric indication

Results
CS was significant in the expectant group

due to Fetal distress

No Difference in perinatal outcome
2 SB in the expectant group
Most of the other trials and meta had more PMR
in the expectant

NNT to Induce to save 1 CS is 30

FETAL SURVEILLANCE

Types

Evidence

FKC
NST
CST
CCTG
BPP
Modified BPP

No RCT on the Freq

1 RCT on the type

Alfirevic et al. 1995

Compared MBPP with the

other Fetal monitoring tool

There were no difference in
out come in the type
But significant reduction in
Fetal distress if started @ 41

SUMMARY

Society of obstetrician and

Gynaecologist
of Canada
1. Accurate Dating

2. Offered the option of membrane sweeping

commencing at 38 to 41 weeks, following a

discussion of risks and benefits.
3. Offered induction at 41+0 to 42+0 weeks
4. Antenatal testing used in the monitoring of the
41- to 42-week pregnancy should include at least
a MBPP
5. Each obstetrical department should establish
guidelines dependent on local resources for
scheduling of labour induction.