Post term or prolonged pregnancy

Dr .shakeri

Definition 42completed weeks or more from

the first day of LMP When last menses was followed

by ovulation 2 week later Post maturity indicating a

pathologically prolonged pregnancy (placental insufficiency +IUGR)

Incidence 3-12% The most common cause is inacurate dating Effect of parity, socioeconomic

class(controversial Previous prolonged pregnancy Recurred across generation(x2-4) Maternal genes influenced prolonged pregnancy Fetal placental factors(x-linked placental

sulfatase deficiency-adrenal hypoplasia-anencephaly)

Young maternal age primiparity

Perinanatal mortality

•After 41w 10.5/1000

•After 43 w 2

•After 44w 3

Complication of prolonged pregnancy

NeonatalAll components of perinatal mortality were increasedShoulder dystociaFetal injuryOligohydraminios Meconium aspirationIntrapartum FHR abnormalitiesStill birth

Maternal

TraumaHemorrhage Labor abnormalities

Amniotic fluidOligohydramnios is frequent

It can be a marker for fetal compromise and risk of cord accidents

Estimate the among of AFAFI ≤ 5Largest vertical pocket ≤ 2

Antenatal test

•Any pregnancy at risk for uteroplacental insufficiencey –candidate for antenatal monitoring•After 41w , antenatal test should be used• the frequency and type of test is based on physician preferences and experience•NST is the first line screen test at many medical centers•CST•BPP

Three protocols1. weekly NST + CST for nonreactive NST2. Twice weekly NST + BPP for nonreactive

NST3. Twice weekly NST + BPP for nonreactive

NST + weekly determination of AFProtocol 1- No intervention and highest

perinatal mortality Protocol 3- Highest intervention and the

least perinatal mortalityC/S was more common in protocol 2 and 3

Fetus Fetal postmaturity syndrome ( Clifford –

1954)Open-eyeAlertAppears old and worried-lookingNails are typically longPeeling , parchmentlike skin Wasted appearanceMeconium stain of skin, membrane, cordOnly small percentage of prolonged

pregnancy

Macrosomia is the most common complication of prolonged pregnancy : Dystocia – brachial plexus injury and fractures

After 39 weeksWeight more than 4000 gr 23%Weight more than 4500 gr 4%

At or after 42 weeks Fetal distress and meconium release ×2Meconium aspiration ×8• There was no increase in the incidence of

birth asphyxia and need for mechanical ventilation at birth

Management and Induction of laborThe risk of still birth increases as G.A

increasesPerinatal mortality and morbidity

increases significantly beyond 41w after 41w, in the presence of favorable

cervix, induction recommendedIf cervix unfavorable Can be watched expectantly with twice

weekly fetal assessmentsOr induction can be undertaken

preventionMembrane sweeping is a safe and

inexpensive method of induction

Membrane sweeping prior to 40w reduce postdate induction

Its safety in GBS positive women has not been established