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Adv. Post Term Pregnancy
Adv. Post Term Pregnancy
Adv. Post Term Pregnancy
OUTLINE
Objective
Introduction
Prevention
11/20/2023 post term 4
Objectives
At the end of the session students should be able to:-
• Define post term pregnancy
Introduction
Definition:
Literally, any pregnancy which has passed beyond the expected date
Introduction ….
Incidence ranges between 4% and 14%.
ETIOLOGY
So long as the complex mechanism in initiation of labor
remains unknown,
the cause of the prolongation of pregnancy will remain obscure.
But certain factors are related with postmaturity.
1. Wrong dates—due to inaccurate LMP (most common)
2. Biological variability (Hereditary) may be seen in the family
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ETIOLOGY……..
3. Maternal factors:
Primiparity, previous prolonged pregnancy, sedentary habit,
elderly multipara
4. Fetal factors:
Congenital anomalies:
Anencephaly → abnormal fetal HPA axis and adrenal hypoplasia
→ diminished fetal cortisol response
5. Placental factors:
Sulfatase deficiency → low estrogen.
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CLINICAL MANIFESTATIONS
• The clinical presentation of postterm infants is based primarily on
fetal growth.
• Macrosomia —
These infants appear normal at birth, apart from their large size.
Cephalopelvic disproportion
Shoulder dystocia
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CLINICAL MANIFESTATIONS…
• Fetal growth restriction —
syndrome:-
• Long, thin, SGA and malnourished infant
CLINICAL MANIFESTATIONS…
Fetal growth restriction……
• In infants with dysmaturity,
• The skin appears loose, especially over the thighs and buttocks,
• scaphoid abdomen
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Diagnosis
Estimation of accurate gestational age by available best methods.
Diagnosis ….
• Diagnosis is based on accurate gestational dating.
2) timing of intercourse
3) Early ultrasound assessment performed before the 24th week
Diagnosis ….
If LNMP is known and reliable,
If she had at least three regular menstrual cycles before the LNMP, and
If she was not using any form of hormonal contraceptives for at least 3
Diagnosis…
If LNMP is not known or not reliable,
Unreliable when
1. Pregnancy occurs during lactational amenorrhea or
2. Soon following withdrawal of the “pill”, confusion arises.
History:
Diagnosis…
Physical Examination:
determination.
11/20/2023 post term 19
Diagnosis…
The suggested clinical findings for postterm are:
• Weight record:
• Obstetric palpation:
• Uterine size, size of the fetus and hardness of the skull bones.
Diagnosis …..
If there is documented early detection of FHR, GA is determined by
adding the lapsed weeks since the date of the detected FHR .
• FHR is detected at the earliest using
Diagnostic Tests:
LNMP.
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DIAGNOSIS…
• The following criteria have been used to establish the diagnosis
of postmaturity retrospectively.
Newborn
(1) General appearance:
• Baby looks thin and old. Skin is wrinkled.
• Body and the cord are stained with greenish yellow color.
(2) Weight
• often more than 3 kg and length is about 54 cm.
Liquor amnii:
Scanty and may be stained with meconium.
Placenta:
There is evidence of aging of the placenta manifested by excessive
infarction and calcification.
Cord:
There is diminished quantity of Wharton’s jelly which may precipitate
cord compression.
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pathology.
Fetal complication
During pregnancy—
There is diminished placental function, oligohydramnios and meconium
stained liquor.
These lead to fetal hypoxia and fetal distress.
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Following birth—
Dystocia
• Shoulder dystocia
Is an obstetric emergency
Dytocia……
• Erb-Duchenne palsy,
Causing the limb to hang limply close to the side, with the forearm
Dystocia …….
• Klumpke paralysis, or paralysis of the hand
MAS….
MAS is not limited to postterm pregnancies
Oligohydramnios
Refers to AFV that is less than expected for GA.
fetal deformation,
death.
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Oligohydramnios…….
Meconium aspiration.
- seizure,
- respiratory insufficiency
polycythemia
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• Epilepsy
deficit disorder
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Investigations
Purpose of investigation:
1. Assessment of maturity
- Amniocentesis
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Investigations…….
2. Assessment of fetal wellbeing:
Fetal kick count by mother
NST- twice weekly
BPP/ Modified BPP
Amniotic fluid volume
Doppler studies of umbilical arteries
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Management
Induction of labor:
If the cervix is unfavorable (bishop score ≤5), ripen the cervix before
induction.
Management ….
• After 41 weeks of gestation the risk of perinatal mortality and
morbidity increases.
• Hence to reduce the risk initiate more frequent antepartum fetal
Management …
• Intrapartum management:
followed closely.
FHB follow up with CTG or strict one to one follow up.
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Prevention
1. Accurate dating by early ultrasound: decreased incidence by
70%
2. Manual nipple stimulation at term
3. Electrical breast stimulation
4. Sweeping of membranes near or at term.
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References
1. Dc duttas Textbook of Obstetrics including Perinatology and Contraception Eighth
Edition
2. Uptodate
3. Williams Obstetrics, 25th Edition F. Gary Cunningham, Kenneth J. Leveno, Steven
L. Bloom, Jodi S. Dashe, Barbara L. Hoffman, Brian M. Casey and Catherine Y.
Spong
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THE END !