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PROLONGED
PREGNANCIES
OUTLINE
How to manage?
Antepartum management
Prognostic factors of successful induction
Overall management recommendation
Intrapartum management
Reference
HOW TO MANAGE?
The decision centers on whether:
Labor induction, or
Expectant management with fetal surveillance
(waiting)
AFI
ANTEPARTUM MANAGEMENT
PGE2 Dinoprostone
vaginal tablet
FOLEY CATHETER
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LAMINARIA TENT
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MANAGEMENT
RECOMMENDATION
Not mandatory but
initiation of fetal
surveillance at 41 weeks
is reasonable.
After completing 42
should
be
induced
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WOMEN OF
CERTAIN
GESTATIONAL
AGE
Labor is induced at week
42
90% are induced
successfully or enter labor
within 2 days of induction
If not deliver:
2nd induction within
3 days
Unusual 3rd
induction
Induction vs LSCS
WOMEN OF
UNCERTAIN
GESTATIONAL
AGE
Weekly nonstress fetal
testing & assessment
of amniotic fluid
AFI 5 cm or reports
of diminished FM
should undergo labor
induction
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INTRAPARTUM
MANAGEMENT
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aspiration
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Amnioinfusion
IMPORTANCE
Successful SVD is reduced in
nulliparous woman who is in early labor
with thick meconium-stained amniotic
fluid.
Hence if she is remote from delivery,
prompt LSCS is considered especially if:
Cephalo-pelvic disproportion
Hypotonic or hypertonic dysfunctional labor
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REFERENCE
Obstetrics Today 2nd Edition
Williams Obstetrics 24th Edition
http://bmc1.utm.utoronto.ca/~amanda/visua
ltoolssite/postdates_basics.html
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