GuidelinesOther guideline
Suspected Prolonged Pregnancy
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
This is pregnancy exceeding 41-42 weeks. There is a risk of intrauterine death, intrapartum hypoxia & meconium aspiration. Suspected prolonged pregnancies are referred to hospital from local clinics. Management is as follows:
- Ensure that the gestational age has been correctly calculated
- A report from an early ultrasound scan (≤24 weeks) should provide convincing evidence of correct gestational age
- If gestation ≥41 weeks, induce labour if no contraindications
- If gestation <41 weeks, ‘stretch & sweep’ the cervix & discharge home
- With uncertainty about gestation (menstrual dates or late ultrasound only):
- Ask about fetal movements, assess the cervix & do ‘stretch & sweep’, &, if necessary, estimate liquor volume on ultrasound
- Induce labour if there are reduced fetal movements, a favourable cervix, or reduced amniotic fluid index (<5 cm) or single deepest pool <2 cm.
- Do not induce labour if fetal movements & liquor volume are normal, & the cervix is unfavourable for induction. Follow up in one week
- During labour, monitor the fetus continuously with CTG