post term or prolonged pregnancy dr.shakeri. definition 42completed weeks or more from the first...
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Post term or prolonged pregnancy
Dr .shakeri
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)
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
Perinanatal mortality
•After 41w 10.5/1000
•After 43 w 2
•After 44w 3
Complication of prolonged pregnancy
NeonatalAll components of perinatal mortality were increasedShoulder dystociaFetal injuryOligohydraminios Meconium aspirationIntrapartum FHR abnormalitiesStill birth
Maternal
TraumaHemorrhage Labor abnormalities
Amniotic fluidOligohydramnios is frequent
It can be a marker for fetal compromise and risk of cord accidents
Estimate the among of AFAFI ≤ 5Largest vertical pocket ≤ 2
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
Three protocols1. weekly NST + CST for nonreactive NST2. Twice weekly NST + BPP for nonreactive
NST3. Twice weekly NST + BPP for nonreactive
NST + weekly determination of AFProtocol 1- No intervention and highest
perinatal mortality Protocol 3- Highest intervention and the
least perinatal mortalityC/S was more common in protocol 2 and 3
Fetus Fetal postmaturity syndrome ( Clifford –
1954)Open-eyeAlertAppears old and worried-lookingNails are typically longPeeling , parchmentlike skin Wasted appearanceMeconium stain of skin, membrane, cordOnly small percentage of prolonged
pregnancy
Macrosomia is the most common complication of prolonged pregnancy : Dystocia – brachial plexus injury and fractures
After 39 weeksWeight more than 4000 gr 23%Weight more than 4500 gr 4%
At or after 42 weeks Fetal distress and meconium release ×2Meconium aspiration ×8• There was no increase in the incidence of
birth asphyxia and need for mechanical ventilation at birth
Management and Induction of laborThe risk of still birth increases as G.A
increasesPerinatal mortality and morbidity
increases significantly beyond 41w after 41w, in the presence of favorable
cervix, induction recommendedIf cervix unfavorable Can be watched expectantly with twice
weekly fetal assessmentsOr induction can be undertaken
preventionMembrane 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