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 w

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

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

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

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

MANAGEMENT 1. Reliable LMP Date known No OCP for 3 mnths 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

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

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

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