POST-TERM POST-TERM PREGNANCYPREGNANCY

Dr.Mona ShroffDr.Mona Shroff(Dept. of O&G .SMIMER)(Dept. of O&G .SMIMER)

DEFINITIONDEFINITIONPOSTTERM: >42 completed weeks POSTTERM: >42 completed weeks

(>294d) (>294d)

POST DATE: >40 completed POST DATE: >40 completed weeks(280d)weeks(280d)

POST MATURITY: Specific syndrome POST MATURITY: Specific syndrome of infant associated with postterm of infant associated with postterm preg preg

INCIDENCEINCIDENCE

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 %

AETIOLOGYAETIOLOGYWrong datesWrong datesBiological-previous prolonged preg.Biological-previous prolonged preg. Irregular ovulationIrregular ovulationDecreased fetal estrogen productionDecreased fetal estrogen production

Placental sulfatase deficiencyPlacental sulfatase deficiency

AnencephalyAnencephaly

Fetal adrenal hypoplasiaFetal adrenal hypoplasiaExtrauterine preg (v. rare)Extrauterine preg (v. rare)

PHYSILOGICAL CHANGES PHYSILOGICAL CHANGES ASS. WITH POSTTERM ASS. WITH POSTTERM

GESTATIONGESTATION PLACENTAL CHANGESPLACENTAL CHANGES : senescence/ageing : senescence/ageing

(increased grading on usg) infarcts,calcification(increased grading on usg) infarcts,calcification

AMNIOTIC FLUID CHANGESAMNIOTIC FLUID CHANGES : : Oligohydramnios (diminished fetal urination) Oligohydramnios (diminished fetal urination)

cloudy (flakes of vernix) cloudy (flakes of vernix) L/S ratio => 4:1 L/S ratio => 4:1

presence of meconium presence of meconium FETAL CHANGESFETAL CHANGES : :

45%-Macrosomia45%-Macrosomia 10%-IU malnutrition10%-IU malnutrition

COMPLICATIONSCOMPLICATIONSMATERNALMATERNAL

AnxietyAnxiety Traumatic Traumatic

vaginal delivery-vaginal delivery-shoulder shoulder dystociadystocia

Increased CS Increased CS raterate

PPH riskPPH risk

FETALFETAL Fetal distressFetal distress MASMAS Fetal traumaFetal trauma brachial plexus brachial plexus

injuries, clavicle injuries, clavicle fracturefracture

Increased Increased perinatal perinatal mortalitymortality

Dysmaturity Dysmaturity syndromesyndrome

MANAGEMENTMANAGEMENT CONFIRMATION OF GESTATIONAL AGECONFIRMATION OF GESTATIONAL AGE

1. Reliable LMP1. Reliable LMP Date knownDate known No OCP for 3 mnthsNo OCP for 3 mnths Regular cyclesRegular cycles2. First trimester CRL(+/-7d)2. First trimester CRL(+/-7d)3. Second trimester BPD (+/- 14d)3. Second trimester BPD (+/- 14d)4. First trimester P/V examination4. First trimester P/V examination5. Doppler FHT 10 wks5. Doppler FHT 10 wks6. Quickening 16-18 wks6. Quickening 16-18 wks

USG USG AFI <5 oligohydramniosAFI <5 oligohydramnios

MacrosomiaMacrosomia

Placental gradingPlacental grading

P/V examinationP/V examination Assess inducibility-BISHOPS Assess inducibility-BISHOPS

scorescore

Identification of patients that need delivery

Ripe cervixOligohydramnios

MacrosomiaAbnormal NST/BPP/CST

Meconium stained liquor

Unripe cxNormal fluid

Normal NST/CSTNormal fetal size

Cervical assessment,NST,AFIWeekly at 40 & 41 wksTwice wkly thereafter

Ripe cxOligo

Abn NST42 WKS

DELIVERY

DELIVERY

INTRAPARTUM INTRAPARTUM MANAGEMENTMANAGEMENT

Left lateral positionLeft lateral positionContinuous electronic fetal monitoringContinuous electronic fetal monitoringEarly ARM in active phase (hastens Early ARM in active phase (hastens

progress, detects meconium)progress, detects meconium)LSCS if CPD/macrosomia,fetal distressLSCS if CPD/macrosomia,fetal distressAmnioinfusion (750-1000ml NS/RL) –If Amnioinfusion (750-1000ml NS/RL) –If

meconium stained liquor,variable meconium stained liquor,variable deccelerationsdeccelerations

Paediatrician called at deliveryPaediatrician called at delivery

PREVENTION PREVENTION

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