1. Post term or prolonged pregnancy Dr.shakeri

2. Definition  42completed weeks or more from the first day of LMP  When last menses was followed by ovulation 2 week later  Post maturity indicating a pathologically prolonged pregnancy (placental insufficiency +IUGR)

3. Incidence  3-12%  The most common cause is inacurate dating  Effect of parity, socioeconomic class(controversial  Previous prolonged pregnancy  Recurred across generation(x2-4)  Maternal genes influenced prolonged pregnancy  Fetal placental factors(x-linked placental sulfatase deficiency-adrenal hypoplasia-anencephaly)  Young maternal age  primiparity

4. Perinanatal mortality After 41w 10.5/1000 After 43 w 2 After 44w 3

5. Complication of prolonged pregnancy  Neonatal  All components of perinatal mortality were increased  Shoulder dystocia  Fetal injury  Oligohydraminios  Meconium aspiration  Intrapartum FHR abnormalities  Still birth

6.  Maternal  Trauma  Hemorrhage  Labor abnormalities

7. Amniotic fluid  Oligohydramnios is frequent  It can be a marker for fetal compromise and risk of cord accidents  Estimate the among of AF  AFI ≤ 5  Largest vertical pocket ≤ 2

8. Antenatal test Any pregnancy at risk for uteroplacental insufficiencey – candidate for antenatal monitoring After 41w, antenatal test should be used the frequency and type of test is based on physician preferences and experience NST is the first line screen test at many medical centers CST BPP

9.  Three protocols 1. weekly NST + CST for nonreactive NST 2. Twice weekly NST + BPP for nonreactive NST 3. Twice weekly NST + BPP for nonreactive NST + weekly determination of AF Protocol 1- No intervention and highest perinatal mortality Protocol 3- Highest intervention and the least perinatal mortality C/S was more common in protocol 2 and 3

10. Fetus  Fetal postmaturity syndrome ( Clifford – 1954)  Open-eye  Alert  Appears old and worried-looking  Nails are typically long  Peeling, parchmentlike skin  Wasted appearance  Meconium stain of skin, membrane, cord  Only small percentage of prolonged pregnancy

11. Macrosomia is the most common complication of prolonged pregnancy : Dystocia – brachial plexus injury and fractures After 39 weeks  Weight more than 4000 gr 23%  Weight more than 4500 gr 4%

12. At or after 42 weeks  Fetal distress and meconium release ×2  Meconium aspiration ×8 There was no increase in the incidence of birth asphyxia and need for mechanical ventilation at birth

13. Management and Induction of labor The risk of still birth increases as G.A increases Perinatal mortality and morbidity increases significantly beyond 41w after 41w, in the presence of favorable cervix, induction recommended If cervix unfavorable  Can be watched expectantly with twice weekly fetal assessments  Or induction can be undertaken

14. prevention Membrane sweeping is a safe and inexpensive method of induction Membrane sweeping prior to 40w reduce postdate induction Its safety in GBS positive women has not been established