POST-TERM PREGNANCY Dr.Mona Shroff (Dept. of O

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POST-TERM PREGNANCYDr.Mona Shroff(Dept. of OG
.SMIMER)
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DEFINITION

• POSTTERM gt42 completed weeks (gt294d)
• POST DATE gt40 completed weeks(280d)
• POST MATURITY Specific syndrome of infant
  associated with postterm preg

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INCIDENCE

• BY LMP 7.5
• BY USG 2.6
• BY LMP USG 1.1
• Previous 1 postterm 27
• Previous 2 postterm 39

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AETIOLOGY

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

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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 gt 41
  presence of meconium
• FETAL CHANGES
• 45-Macrosomia
• 10-IU malnutrition

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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

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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

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• USG
• AFI lt5 oligohydramnios
• Macrosomia
• Placental grading
• P/V examination
• Assess inducibility-BISHOPS score

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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

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PREVENTION

• Sweeping/stripping of membranes at term if no
  vaginitis, malpresentation or placenta praevia