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Postterm pregnancy & induction of labor
- 1. Dr.Tarig Mahmoud Ahmed MDSUDAN HAIL UNIVERSITY KSA
- 2. A pregnancy thathas extended to or beyond 42 weeks gestation is defined as a prolonged or post-term pregnancy. Accurate dating remains essential for the correct diagnosis and ideally involve a first trimester ultrasound estimation of crown– rump length.
- 3. Post-term pregnancy affectsapproximately 10 per centofallpregnancies. Post-term pregnancy increased risk of prolonged labour and Caesarean section and increased risk ofstillbirthandperinataldeath(atleasttwo-fold). post-term pregnancies increasedrisk of meconium aspiration syndrome (MAS) . Meconium can be aspirated before or after birth.
- 4. therearenoknownteststhatcanaccuratelypredictfetal outcomeinpost-termpregnancy. Fetalsurveillance and induction of labour are two strategies employed that may reduce the risk of adverse outcome.
- 5. 1. Reduced amnioticfluid on scan. 2. Reduced fetal growth . 3. Reduced fetal movements. 4. CTG is not perfect. 5. Mother is hypertensive. Immediate indications for induction of labour or delivery in postdates
- 6. Induction of labouris the planned initiation of labour prior to its spontaneous onset. Approximately one in five deliveries in the UK occur following induction of labour. Induction of labour
- 7. 1. Prolonged pregnancy. 2.Fetal growth restriction. 3. Pre-eclampsia and other maternal hypertensive disorders. 4. Deteriorating maternal illnesses. 5. Prelabour rupture of membranes. 6. Unexplained antepartum haemorrhage. 7. Diabetes mellitus. 8. Twin pregnancy continuing beyond 38 weeks. 9. Intrahepatic cholestasis of pregnancy. 10. Maternal iso-immunization against red cell antigens. 11. ‘Social’ reasons. Common indications for induction of labour
- 8. IOL usually recommendedbetween 41 and 42 weeks gestation in Post term pregnancy . Induction for prolonged pregnancy does not increase the rate of Caesarean section. At term (beyond 37 weeks),good quality evidence supports IOL approximately 24 hours following membrane rupture (PROM).
- 9. Pre-eclampsia atterm is normally managed with IOL, however at very preterm gestations (34 weeks), or where there is rapid deterioration or significant fetal compromise, Caesarean delivery may be a better option.
- 10. Maternal diabetes, twingestation and intrahepatic cholestasis are all common reasons forIOLat38weeksgestation. Suspected fetal macrosomia, in the absence of maternal diabetes, and isolated oligohydramnios at term are NOT evidence-based indications for IOL.
- 11. ‘Social’ inductionof labour is controversial and is performed to satisfy the domestic and organizational needs of the woman and her family. It is mostly discouraged, and there must be careful counselling as to the potential risks involved.
- 12. placenta praevia . severe fetal compromise. Deteriorating maternal condition with major antepartum haemorrhage. cardiac disease may favour Caesarean delivery. Breech presentation. women with a previous history of caesarean birth need to be informed of the greater risk of uterine rupture. contraindications to IOL
- 13. High scores (a‘favourable’ cervix) are associated with an easier, shorter induction that is less likely to fail. Low scores (an ‘unfavourable’ cervix) point to a longer IOL that is more likely to fail and result in Caesarean section. Bishop score
- 14. Score 0 12 3 Dilatation of cervix (cm) 0 1 or 2 3 or 4 5 or more Consistency of cervix Firm Medium Soft – Length of cervical canal (cm) >2 2–1 1–0.5 <0.5 Position of cervix Posterior Central Anterior – Station of presenting part -3 -2 -1 or 0 Below spines Bishop score
- 15. ARM and oxytocin: Oxytocin is given intravenously, as a dilute solution particularly in primiparous . The starting infusion rate is low and then increase follow every 30 minutes until 3–5 contractions are achieved every 10 minutes. Methods
- 16. Prostaglandin: Various routes andvarious preparations have been used. PGE2, inserted vaginally into the posterior fornix as a tablet or gel. Two doses are often required, given at least 6 hours apart. A controlled-release pessary is also available and this is left in place for up to 24 hours.
- 17. Mifepristone (an anti-progesterone)and misoprostol (another prostaglandin) can be used to induce labour, but complication rates seem higher and this drug combination is currently used in the UK only to induce labour following intrauterine fetal death.
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- 20. ‘Membrane sweeping’ : describesthe insertion of a gloved finger through the cervix and its rotation against the wall of the uterus. It releases natural prostaglandins but It can be uncomfortable for the woman.
- 21. Greater pain inlabour. Uterine hyperstimulation. Cord prolapse (ARM + high head). Greater risk of uterine rupture during VBAC. Failure. Increased need for Caesarean or instrumental delivery. Fetal compromise . Risks of induction of labour
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