1 / 15

Post term Pregnancy

Post term Pregnancy. Definitions:. postdates pregnancy - patient who has not delivered by end of 42nd week or 294 days from first day of last menstrual period (LMP) prolonged pregnancy - exceeds 40 weeks (280 days) from known time of ovulation. Incidence:.

titus
Télécharger la présentation

Post term Pregnancy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Post term Pregnancy

  2. Definitions: • postdates pregnancy - patient who has not delivered by end of 42nd week or 294 days from first day of last menstrual period (LMP) • prolonged pregnancy - exceeds 40 weeks (280 days) from known time of ovulation

  3. Incidence: • 27 percent of pregnancies deliver in the 40th and 41st week . • 5.5 percent deliver at ≥42 weeks.

  4. Incidence: • pregnancies dated by first trimester ultrasound examination: • ≥41 weeks ranges from 5 to 11 percent • ≥42 weeks is about 2 percent

  5. Causes: • The commonest cause is error in calculation of gestational age. • Congenital anomalies like anencephaly which disrupt foetal pitutary adrenal axis and rare maternal enzyme deficiencie(placental sulphatase. • In most cases cause is not known.

  6. Risk Factors • Maternal or paternal personal history of postterm birth • Nulliparity • Male fetus • Maternal obesity • Older maternal age • lower socioeconomic groups

  7. Pathogenesis: • amniotic fluid volume decreases • amniotic fluid volume reaches maximum at 24 weeks, constant until 37 weeks, then decreases • decreased amniotic fluid volume associated with decreased fetal movement and fetal heart rate decelerations

  8. A. Fetal Complications • Still birth rate increases significantly at term with advancing gestation. • It is 0.35/1000 pregnancies at 37 weeks • While 2.12/1000 pregnancies at 43 weeks.

  9. Meconiumaspiration • Macrosomia • Asphyxia before, during and after delivery • Fractures and Peripheral nerve injury • Pneumonia • Septicaemia • Intra cranial hemorrhage

  10. Dysmaturity(postmaturity syndrome) • Incidence 20% • stage 1 - alert facial expression; recent weight loss with decreased subcutaneous fat and muscle mass • stage 2 - green meconium staining of skin and umbilicus, fetal distress, hypoxia • stage 3 - yellow staining of nails, skin and umbilicus indicative of prolonged passage of meconium

  11. B. Maternal Complications • cesarean delivery • rates of primary cesarean delivery • 8.2% at 38 weeks • 8.8% at 39 weeks • 9% at 40 weeks • 14% at 41 weeks (p < 0.001) • 21.7% at ≥ 42 weeks (p < 0.001)

  12. operative vaginal delivery • 8.8% at 38 weeks • 9.4% at 39 weeks • 10.9% at 40 weeks (p < 0.001) • 13.3% at 41 weeks (p < 0.001) • 17.4% at ≥ 42 weeks (p < 0.001)

  13. postpartum hemorrhage, starting at 38 weeks • third- or fourth-degree laceration, starting at 39 weeks • prolonged labor (> 24 hours), starting at 39 weeks • chorioamnionitis, starting at 40 weeks • endomyometritis, starting at 41 weeks

  14. Induction versus expectant management: • compared with delivery induction, expectant management associated with • decreased mortality risk at 37 weeks gestation (relative risk [RR] 0.87. 95% CI 0.77-0.99) • similar mortality risk at 38 weeks gestation (RR 1.11, 95% CI 1-1.22) • increased mortality risk at • 39 weeks gestation (RR 1.47, 95% CI 1.35-1.59) • 40 weeks gestation (RR 1.58, 95% CI 1.45-1.71) • 41 weeks gestation (RR 1.63, 95% CI 1.47-1.81) Reference - Obstet Gynecol 2012 Jul;120(1):76

  15. Prevention: • Recording LMP and calculating EDD at the time of first ANC visit. • Routine early ultrasound for dating of pregnancy. • Review of antenatal card and ultra sonographic reports in terms of fetal growth. • Sweeping of membranes from 38 wks onwards decreases number of pregnancies going beyond 41 and 42 wks. • As soon as prematurity is ruled out in high risk cases induction of labour will prevent post maturity.

More Related