POST-TERM PREGNANCY

Dr.Mona Shroff

Dr. Mona Shroff 1

www.obgyntoday.info
 DEFINITION
 POSTTERM: >42 completed weeks
(>294d)

 POST DATE: >40 completed weeks(280d)

 POST MATURITY: Specific syndrome of

infant associated with postterm preg

Dr. Mona Shroff 2

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 INCIDENCE
 BY LMP : 7.5 %
 BY USG : 2.6 %
 BY LMP + USG : 1.1 %
 Previous 1 postterm : 27 %
 Previous 2 postterm : 39 %

Dr. Mona Shroff 3

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 AETIOLOGY
 Wrong dates
 Biological-previous prolonged preg.
 Irregular ovulation
 Decreased fetal estrogen production
Placental sulfatase deficiency
Anencephaly
Fetal adrenal hypoplasia
 Extrauterine preg (v.v. rare)
Dr. Mona Shroff 4

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 PHYSILOGICAL CHANGES ASS.
WITH POSTTERM GESTATION
 PLACENTAL CHANGES : senescence/ageing
(increased grading on usg) infarcts,calcification

 AMNIOTIC FLUID CHANGES :

Oligohydramnios (diminished fetal urination)
cloudy (flakes of vernix)
L/S ratio => 4:1
presence of meconium
 FETAL CHANGES :
45%-Macrosomia
10%-IU malnutrition

Dr. Mona Shroff 5

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 COMPLICATIONS
MATERNAL FETAL
 Anxiety  Fetal distress
 Traumatic vaginal  MAS
delivery-shoulder  Fetal trauma
dystocia brachial plexus
 Increased CS rate injuries, clavicle
 PPH risk fracture
 Increased perinatal
mortality
 Dysmaturity
syndrome
Dr. Mona Shroff 6

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 MANAGEMENT
CONFIRMATION OF GESTATIONAL AGE

1. Reliable LMP
Date known
No OCP for 3 mnths
Regular cycles
2. First trimester CRL(+/-7d)
3. Second trimester BPD (+/- 14d)
4. First trimester P/V examination
5. Doppler FHT 10 wks
6. Quickening 16-18 wks
Dr. Mona Shroff 7

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 USG
AFI <5 oligohydramnios
Macrosomia
Placental grading

 P/V examination
Assess inducibility-BISHOPS score

Dr. Mona Shroff 8

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 Identification of patients that need delivery

Ripe cervix
Unripe cx
Oligohydramnios
Normal fluid
Macrosomia
Normal NST/CST
Abnormal NST/BPP/CST
Normal fetal size
Meconium stained liquor

Cervical assessment,NST,AFI
DELIVERY Weekly at 40 & 41 wks
Twice wkly thereafter

Ripe cx
Oligo
Abn NST
42 WKS

DELIVERY
9
Dr. Mona Shroff
www.obgyntoday.info
INTRAPARTUM MANAGEMENT
 Left lateral position
 Continuous electronic fetal monitoring
 Early ARM in active phase (hastens
progress, detects meconium)
 LSCS if CPD/macrosomia,fetal distress
 Amnioinfusion (750-1000ml NS/RL) –If
meconium stained liquor,variable
deccelerations
 Paediatrician called at delivery
Dr. Mona Shroff 10

www.obgyntoday.info
 PREVENTION
Sweeping/stripping of
membranes at term
if no vaginitis,
malpresentation or
placenta praevia

Dr. Mona Shroff 11

www.obgyntoday.info
THANK YOU

Dr. Mona Shroff 12

www.obgyntoday.info