POST-TERM PREGNANCY Dr.Mona Shroff 1 Dr. Mona Shroff

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

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

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

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

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

MANAGEMENT CONFIRMATION OF GESTATIONAL AGE CONFIRMATION OF GESTATIONAL AGE 1. Reliable LMP Date known Date known No OCP for 3 mnths No OCP for 3 mnths Regular cycles 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 wks 7 Dr. Mona Shroff

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

Identification of patients that need delivery Ripe cervix Oligohydramnios Macrosomia Abnormal NST/BPP/CST Meconium stained liquor DELIVERY Unripe cx Normal fluid Normal NST/CST Normal fetal size Cervical assessment,NST,AFI Weekly at 40 & 41 wks Twice wkly thereafter Ripe cx Oligo Abn NST 42 WKS DELIVERY 9 Dr. Mona Shroff

INTRAPARTUM MANAGEMENT Left lateral position Left lateral position Continuous electronic fetal monitoring Continuous electronic fetal monitoring Early ARM in active phase (hastens progress, detects meconium) Early ARM in active phase (hastens progress, detects meconium) LSCS if CPD/macrosomia,fetal distress LSCS if CPD/macrosomia,fetal distress Amnioinfusion ( ml NS/RL) –If meconium stained liquor,variable deccelerations Amnioinfusion ( ml NS/RL) –If meconium stained liquor,variable deccelerations Paediatrician called at delivery Paediatrician called at delivery 10 Dr. Mona Shroff

PREVENTION Sweeping/stripping of membranes at term if no vaginitis, malpresentation or placenta praevia 11 Dr. Mona Shroff

THANK YOU 12 Dr. Mona Shroff