Reviewer: POSTTERM PREGNANCY • ↓ Fetal renal blood flow →

POSTTERM PREGNANCY ↓ urination → oligohydramios

• Definition: • Meconium release during oligo-
 > 42 0/7 weeks hydramnios → meconium aspiration
 294 days after LMP syndrome
 LMP was followed by ovulation after 2 weeks
• Common result: Stillbirth (in growth
• There may be errors in the estimation of AOG d/t faulty
Fetal Growth restricted postterm newborns
menstrual date or delayed ovulation → may not really postterm
Restriction delivered after 42 weeks)
Means of getting AOG: • ↑ risk of morbidity and mortality
• 1st tri. sonography – MOST ACCURATE to conform
AOG; at 9 weeks; MOE: 5 days POSTTERM COMPLICATIONS
• 2nd & 3rd tri. US – correction of AOG • Oligohydramnios
• 1st few weeks of missed menses and (+) pregnancy test • Macrosomia
• Fundic height – At 18 – 32 weeks → FUNDIC HEIGHT • Measurement: AFI or deepest
(cm) = AOG vertical pocket ≤ 1 cm
12 weeks AOG Just above symphysis pubis • Associated w: CS and operative
Oligohydramnios
16 weeks AOG B/w symphysis pubis & umbilicus vaginal delivery, low 5 min APGAR,
20 weeks AOG Level of umbilicus fetal acidemia, fetal compromise
during labor admission to NICU
Predisposing Factors to Postterm Pregnancy
• Peak velocity of weight gain: 37
BMI ≥ 25 Altered metabolic function weeks (most continue to grow)
Macrosomia
• Hard to initiate contraction + ↓ gap • 4475 at 42 weeks: 95th percentile
Nulliparity junctions in myometrium • VAGINAL delivery if (-) DM
• Long cervix (3rd/4th quartile)
• ↓ ESTROGEN but rare ANTEPARTUM MANAGEMENT
Fetal & placental
• Anencephaly, Adrenal hypoplasia, X- • Depends if labor induction is warranted or if expectant
factors
linked placental sulfatase deficiency management with fetal surveillance is best
Biological • Includes:
Maternal genes ONLY  Induction factors
predisposition
 Fetal testing at 41 weeks

PRENATAL MORTALITY AND MORBIDITY

Induction Factors
• Increased risk of:
• Unfavourable cervix
 Rates of still birth, fetal death, infant morbidity
 Has no precise objective definition
 CS → dystocia, fetal distress
 Undilated cervix – seen in some pregnancy >41 weeks,
 Cerebral palsy
has higher CS rate for dystocia
 Lower IQ at 6.5 y/o
 < 3 cm or < 25 mm cervical length = successful infection
 Neonatal seizures
• NOT effective:
• Autism NOT associated w/ postterm birth
 PGE2 gel
• Pathophysiology:
 Sweeping or stripping of the membranes – does not
 Postmature Syndrome
induce labor; can l/t pain, vaginal bleeding, irregular
 Placental dysfunction
contractions without labor, high rates of CS
 Fetal distress and oligohydramnios
 Fetal growth restriction Fetal Testing at 41 weeks
• Fetal movement (FM) – 2 hours/day
• Skin: wrinkling (palms & soles), • Nonstress test (NST) – 3x/week
patchy, peeling → d/t loss of vernix • Amniotic fluid volume (AFV) – 2 – 3x/week (abnormal: < 3cm)
caseosa
Postmature • Wasting – long and thin baby MANAGEMENT of Postterm Pregnancy
Syndrome • Advanced maturity: open eyes, old
and worried, unusually alert
• Long nails
• NOT technically growth restricted
• PLACENTAL APOPTOSIS
✓ Greater at 41 – 42 weeks
✓ Upregulated: Kisspeptin
Placental (proapoptotic gene)
dysfunction • ↑ Cord blood erythropoietin level:
suggests decreased oxygenation
• Placental senescence – postmaturity
syndrome
• CORD COMPRESSION associated
Fetal distress &
w/ oligohydramnios → PROLONED
oligohydramnios
DECELERATION (fetal distress)
• If AOG is uncertain → delivery at 41 WEEKS using best
estimate for AOG
• DO NOT DO AMNIOCENTESIS for fetal lung maturity
• Uncertain postterm pregnancies → manage by:
 Weekly NST
 Assess AFV

LABOR INDUCTION
• Known AOG, induced at completion of 42 weeks
• AFV ≤ 5 cm
• (+) Diminished fetal movement
• IF: Does not deliver during 1st induction → 2nd induction
WITHIN 3 DAYS

INTRAPARTUM MANAGEMENT
• Monitor labor
• Amniotomy
• Cesarean section if remote from delivery

Monitor Labor
• Monitor FHR and uterine contractions
• Scalp electrode and intrauterine pressure catherer – can
be placed AFTER membrane rupture → provides more
precise data about FHR and uterine contractions

Amniotomy
• Aids in identification of thick meconium (worrisome)
 Signifies lack of liquid (oligohydramnios)
 Aspiration of thick meconium → severe pulmonary
dysfunction, neonatal death
 Amnioinfusion – diluting meconium; not effective
• Reduced successful vaginal delivery in nullipara with thick,
meconium-stained amniotic fluid → prompt CS
• Amniotomy during labor → can further reduce fluid volume
→ cord compression

Cesarean Section
• Indications:
 Woman is remote from delivery
 Suspected cephalopelvic disproportion
 Evident hypotonic or hypertonic dysfunction labor