1. No category

POST--TERM PREGNANCY
POST
Prof. Mostafa A. AbdelAbdel-lah
Prof. Moustafa A. AbdelAbdel-lah
1
DEFINITION
z
POSTTERM: >42
>42 completed weeks
(>294
(>
294d)
d)
z
POST DATE: >40 completed weeks(280
weeks(280d)
d)
z
POST MATURITY: Specific
p
syndrome
y
of
infant associated with postterm preg
Prof. Moustafa A. AbdelAbdel-lah
2
INCIDENCE
z BY
LMP : 7.5 %
z BY U/S
: 2.6 %
z BY LMP + U/S : 1.1 %
z Previous
P
i
1 postterm
tt
: 27 %
z Previous 2 postterm : 39 %
Prof. Moustafa A. AbdelAbdel-lah
3
AETIOLOGY
Wrong dates
z Biological
Biological--previous prolonged preg
preg..
z Irregular ovulation
z ↓ fetal estrogen production
- Placental sulfatase deficiency
y
- Anencephaly
- Fetal
F t l adrenal
d
l hypoplasia
h
l i
z Extrauterine
u
preg
p g (v.v. rare))
z
Prof. Moustafa A. AbdelAbdel-lah
4
PHYSILOGICAL CHANGES ASS.
WITH POSTTERM GESTATION
z
PLACENTAL CHANGES : senescence/ageing
(increased grading on U/S) infarcts, calcification
AMNIOTIC FLUID CHANGES :
Oligohydramnios (diminished fetal urination)
cloudy (flakes of vernix
vernix))
L/S ratio => 4:1
presence of meconium
z FETAL CHANGES :
45%
45
%-Macrosomia
10%
10
%-IU malnutrition
z
Prof. Moustafa A. AbdelAbdel-lah
5
COMPLICATIONS
z
z
z
z
MATERNAL
Anxiety
T a matic vaginal
Traumatic
aginal
delivery--shoulder
delivery
dystocia
Increased CS rate
PPH risk
z
z
z
z
z
FETAL
Fetal distress
MAS
Fetal trauma
brachial plexus
injuries, clavicle
fracture
Increased perinatal
mortality
Dysmaturity
syndrome
Prof. Moustafa A. AbdelAbdel-lah
6
MANAGEMENT
CONFIRMATION OF GESTATIONAL AGE
1. Reliable LMP
Date known
Expected
No OCP for 3 mnths
R
Regular
l cycles
l
2. First trimester CRL(+/
CRL(+/--7d)
3. Second trimester BPD (+/(+/- 14
14d)
d)
4. First trimester P/V examination
5. Doppler FHT 10 wks
Moustafa A. AbdelAbdel-lah
6. Quickening 1616-18Prof.
wks
7
z U/S
/
AFI <5
<5 oligohydramnios
Macrosomia
Placental grading
z P/V
examination
i ti
Assess inducibility
inducibility--BISHOPS score
Prof. Moustafa A. AbdelAbdel-lah
8
Identification of patients that need delivery
Ripe cervix
Oligohydramnios
Macrosomia
Abnormal NST/BPP/CST
Meconium stained liquor
DELIVERY
Unripe cx
Normal fluid
Normal NST/CST
Normal fetal size
Cervical assessment,NST,AFI
Weekly at 40 & 41 wks
Twice wkly thereafter
Ripe cx
Oligo
Abn NST
42 WKS
DELIVERY
Prof. Moustafa A. AbdelAbdel-lah
9
INTRAPARTUM MANAGEMENT
L f lateral
Left
l
l position
ii
z Continuous electronic fetal monitoring
g
z Early ARM in active phase (hastens
progress detects meconium)
progress,
z LSCS if CPD/macrosomia,fetal distress
z Amnioinfusion
f
((750
7500-1000
1000ml
000mll NS/RL)
S/ ) –Iff
meconium stained liquor,variable
deccelerations
z Paediatrician
aed at c a ca
called
ed at de
delivery
ey
z
Prof. Moustafa A. AbdelAbdel-lah
10
PREVENTION
Sweeping/stripping of
membranes
b
att term
t
if no vaginitis
vaginitis,,
malpresentation or
placenta praevia
Prof. Moustafa A. AbdelAbdel-lah
11
THANK YOU
Prof. Moustafa A. AbdelAbdel-lah
12