1. POST-TERM PREGNANCY Dr.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 w

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: 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 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 wks

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

10. 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 ( ml NS/RL) –If meconium stained liquor,variable deccelerations
Paediatrician called at delivery

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