post term pregnancy
TRANSCRIPT
POST-TERM PREGNANCYPOST-TERM PREGNANCY
Dr Max MongelliWomen & Childrens’ Health
Nepean HospitalSydney, Australia
Max Mongelli 2011
DefinitionsDefinitions
Pregnancy has extended to or beyond 42 weeks from LMP
“Post-dates” applies to pregnancy over 40 and less than 42 weeks
Critically dependent on accurate pregnancy dating
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PrevalencePrevalencePrevalence of post-term pregnancy highly
dependent on local policies for induction. preterm delivery rates, complicated pregnancy rates
In the USA about 6% of pregnancies are post-term
Using 1st trimester scans for dating results in only 2% of pregnancies going post-term
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Risk FactorsRisk Factors
PrimigravidityPrevious post-term pregnancyGenetic factorsMale fetusMaternal obesityFetal anencephaly
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PathophysiologyPathophysiology
Deterioration in placental functionIncreased placental apoptosisIncreased cord blood erythropoetin
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Risks to the FetusRisks to the Fetus
Doubling of perinatal mortalityAsphyxia, meconium aspiration,
intrauterine sepsisFetal macrosomiaFetal dysmaturity syndrome
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Risks to the MotherRisks to the Mother
Increased risk of labor abnormalitiesThird and fourth degree perineal tearsIncreased risk of cesarean delivery
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ManagementManagement
Induction of laborMembrane sweepingConservative management
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Induction of LaborInduction of Labor
This is the preferred course of managementMost units induce labor from 41 weeks
onwardsStrong evidence from meta-analysis to
support reduced perinatal mortality, morbidity and cesarean section rates
Shown to be cost-effective
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Membrane SweepingMembrane Sweeping
Membrane sweeping (or “stripping”) may be used to prevent post-term pregnancy
Reduces the percentage of patients going postterm from 41% to 23%
Can be repeated if required
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Conservative ManagementConservative Management
Reserved for women who decline induction or labor or have a contraindication
Optimal gestational age for beginning monitoring is unknown, usually 41-42 weeks
Monitoring should include amniotic fluid assessment, CTG’s
Immediate delivery if these become abnormal
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Intrapartum ManagementIntrapartum Management
Continuous electronic fetal monitoring is required
Greater risk of fetal distress or meconium aspiration
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PrognosisPrognosis
No detectable differences in children born postterm regarding IQ, physical milestones or intercurrent illnesses, when tested at 1-2 years of age.
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Further ReadingFurther Reading
Williams’ Obstetrics
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