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POST-TERM PREGNANCY Dr.Mona Shroff (Dept. of O&G .SMIMER)

POST-TERM PREGNANCY Dr.Mona Shroff (Dept. of O&G .SMIMER). DEFINITION. POSTTERM: >42 completed weeks (>294d) POST DATE: >40 completed weeks(280d) POST MATURITY: Specific syndrome of infant associated with postterm preg. INCIDENCE. BY LMP : 7.5 % BY USG : 2.6 %

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POST-TERM PREGNANCY Dr.Mona Shroff (Dept. of O&G .SMIMER)

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  1. POST-TERM PREGNANCYDr.Mona Shroff(Dept. of O&G .SMIMER)

  2. DEFINITION • POSTTERM: >42 completed weeks (>294d) • POST DATE: >40 completed weeks(280d) • POST MATURITY: Specific syndrome of infant associated with postterm preg

  3. INCIDENCE • BY LMP : 7.5 % • BY USG : 2.6 % • BY LMP + USG : 1.1 % • Previous 1 postterm : 27 % • Previous 2 postterm : 39 %

  4. AETIOLOGY • Wrong dates • Biological-previous prolonged preg. • Irregular ovulation • Decreased fetal estrogen production Placental sulfatase deficiency Anencephaly Fetal adrenal hypoplasia • Extrauterine preg (v. rare)

  5. PHYSILOGICAL CHANGES ASS. WITH POSTTERM GESTATION • PLACENTAL CHANGES : senescence/ageing (increased grading on usg) infarcts,calcification • AMNIOTIC FLUID CHANGES : Oligohydramnios (diminished fetal urination) cloudy (flakes of vernix) L/S ratio => 4:1 presence of meconium • FETAL CHANGES : 45%-Macrosomia 10%-IU malnutrition

  6. COMPLICATIONS MATERNAL • Anxiety • Traumatic vaginal delivery-shoulder dystocia • Increased CS rate • PPH risk FETAL • Fetal distress • MAS • Fetal trauma brachial plexus injuries, clavicle fracture • Increased perinatal mortality • Dysmaturity syndrome

  7. MANAGEMENT CONFIRMATION OF GESTATIONAL AGE 1. Reliable LMP Date known No OCP for 3 mnths Regular cycles 2. First trimester CRL(+/-7d) 3. Second trimester BPD (+/- 14d) 4. First trimester P/V examination 5. Doppler FHT 10 wks 6. Quickening 16-18 wks

  8. USG AFI <5 oligohydramnios Macrosomia Placental grading • P/V examination Assess inducibility-BISHOPS score

  9. INTRAPARTUM MANAGEMENT • Left lateral position • Continuous electronic fetal monitoring • Early ARM in active phase (hastens progress, detects meconium) • LSCS if CPD/macrosomia,fetal distress • Amnioinfusion (750-1000ml NS/RL) –If meconium stained liquor,variable deccelerations • Paediatrician called at delivery

  10. PREVENTION Sweeping/stripping of membranes at term if no vaginitis, malpresentation or placenta praevia

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