MD1TALK

Post-term Pregnancy

-post-term pregnancy: its a pregnancy that reached or >42 weeks ,

Late term (post-date) : 41+0 - 41+6
-mortality rate is higher after 41w-> so we have to mange after 41w and even
before in high risk pregnancy.
RF : POP 🥤
-primi (‫)ﻣﺣﺎﻓظﺔ ﻋﻠﻰ ﻧﻔﺳﮭﺎ ﺑزﯾﺎدة‬
-previous post-term pregnancy.
-obesity
physiology of parturition*giving birth* : begins with a stimulus in
fetal brain -> activation HP axis-> adrenal increases DHEAS and cortisol.
placental sulfatase convert the DHEAS to E3 -> increasing myometrial
activity, and cortisol->stimulating prostaglandin synthesis.
ETIOLOGY:
-MCC is miscalculation in LMP (either wrong dates or irregular mens
that cause delay ex: mens every 35d -> delay ovulation 7 days due Luteal
phase is always fixed but follicular is prolonged -> you think that is PTP)
-if calculation is correct cause is usually unknown
-there is association with :
-anencephalic fetus(adrenals are hypoplastic)
- placental sulfatase deficiency
- CAH
Complication Of PTP :
IF no placenta insufficiency has occurred-> macrosomia
IF placenta insufficiency has occurred due to aging of placenta->infarction
and calcification of vessels ->chronic asphyxia:
1. MAS
2. oligohydramnios (shift of blood to vitals -> dec GFR ) -> cord comp
and more insufficiency
3. Post-maturity syndrome *‫ *شايب‬: occurs when a growth restricted
fetus remains in utero beyond term.
C/F: loss of subcutaneous fat, long finger nails, dry peeling
skin, and abundant hair.
4. IUFD or IUGR
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DIAGNOSIS
-key to dx & management is accurate dating of gestation (CRL in 1st T + LMP)
management :
-Timing of Delivery is indicated :
-if high risk (GDM or HTN) -> induction at 40 weeks
-low-risk -> induction of labor at 41 weeks if cervix is favorable ,If unfavorable then
expectant management with AFS (Any abnormal antenatal testing)? Induction
-at 42 weeks if cervix remains unfavorable?give PG to “ripen”cervix-> induction.

A .Induction of Labor*preventing PTP*:

-success of induction is dependent on Bishop score
-score >8 favorable (Induction is usually successful)
-score <5-4 unfavorable(induction mostly will fail)

Call PEDS (max 13)

B  Expectant management with antenatal testing:

- do Antenatal testing twice a week between 41 and 42 weeks it include :
- NST +- CST or modified BPP
1. NST:
-Reactive(Reassuring) NST: 2 accelerations with good baseline and
variability and absence of deceleration—> no further testing.
-nonreactive after 40 minutes -> do modified BPP or CST
2. CST:
A negative CST(reassuring): no late decelerations with 3 uterine
contractions lasting 1min each over a 10-min
A positive CST: late decelerations with > 50% of contractions.
equivocal: inconsistent late decelerations
If fetus > 41 weeks’ and CST is equivocal or positive -> delivery
3.Modified Biophysical profile: NST and AFI
-> if they affected rest of BPP is affected.
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if either NST is nonreactive or AFI <5cm (Oligohydramnios)-> ominous sign
suggest placental insufficiency->delivery

Induction of Labor
Def : initiation of labor by artificial methods
-not used for convenience of mother or her family, and it should not be
done before 38 weeks’ because of possibility of neonatal morbidity.
Augmentation : stimulation of labor that has begun.
-1st do BISHOP: >8 this fav cervical condition and you should start
induction
<5 this unfavorable for induction -> do cervical ripping(softening)
cervical ripening methods:
Pharma :
-Misoprostol (Cytotec): 25-µg placed intravaginally( one pill 200ug)
-Cervidil *dinoprostone*PGe2*: intra-vaginal
Advantage : can be removed quickly if medication causes
hyperstimulation.
Mechanical:
-placement of catheter into cervix : inflation of balloon and mechanically
draw.
-Osmotic dilators : act as sponge to absorb fluid from cervix.
-Amniotomy*AROM*: indication cervix fully dilated , head is well applied on
cervix-> gush of PGs
After cervical ripening -> initiate contraction *induction* :
-CI of induction:
1-vertical incision(either classical C section* or Lower
uterine vertical section) , Placenta previa , contracted pelvis ,
abnormal presentation , acute fetal distress
-lower transverse section is not CI ->this is called VBAC.
TECHNIQUE FOR INDUCTION OF LABOUR:
1-blood must be typed and screened for antibodies
2-Continuous*CTG*
3-Oxytocin Infusion (only drug approved for induction and
augmentation of labor)
-must be given IV to allow discontinuation quickly*90s half life*
(if uterine hypertonus or fetal distress develops)
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-should not exceed 72 hours.

COMPLICATIONS:
-uterine hyper-stimulation*Tachysystol*(with excessive infusion)
-> more than 5 contraction in 10 min ->fetal distress from ischemia or
tetanic contraction ->lead to uterine rupture
-water intoxication > hyponatremia (convulsions and coma)
(structure similar to ADH)
-prolonged infusion ->uterine atony (hypotonus) ->PPH
-hypotension due VD

Term : 39-41w*her is your aim to induce*

-most important US at 1st trimester (CRL) margin of error 5 days.
-If NST and amniotic fluid pocket -> if there affection here -> all of remaingn is
affected of BPP so thats why we do both only
-Doppler have no rule except in IUGR

CI for induction: placenta previa , cord prolapse, ->> C-section

Cord prolapse *mhm*