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Prolonged pregnancy (Diagnosis (History (PC/HPC
Overdue 42wk, Current…
Prolonged pregnancy
Diagnosis
Examination
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Abdominal
Foetal size, lie, engagement
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History
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Current pregnancy
Scans, bloods, general health
POH
Previous prolonged, conception, delivery,
gestation, complications
PGH
Conditions, menses (irregular?),
contraception, STIs, smears
PMH
Known conditions, abdo/pelvic surgery
DH
Current meds, allergies
SH
Occupation, social support,
smoking, alcohol
Management
Medical
Induction of labour
Indication: 41-42wk, maternal choice
Benefits: reduced perinatal mortality, CS
Risks: medicalises labour
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Conservative
Stretch and sweep (41 wk)
Await spontaneous delivery (but risk perinatal morbidity/mortality)
Pathophysiology
Unreliable dates
Uncertainty of LMP
Irregular periods
Recent COCP use
Conception during lactational amenorrhoea
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Complications
Maternal
Psychiatric morbidity (anxiety)
Interventions (IoL, operative delivery)
Foetus
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Neonatal
Death
Hypothermia
Hypoglycaemia
Polycythaemia
Growth restriction
Foetal postmaturity syndrome (rare; see signs of intrauterine malnutrition e.g. scaphoid abdomen, little SC fat, peeling palms/feet, overgrown nails, anxious/alert, meconium stained)
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