POST TERM PREGNANCY By Dr. Elioba.pptx

Post Term Pregnancy By Dr. Elioba J. Raimon

1. POST TERM PREGNANCY DR . ELIOBA J. RAIMON MBChB -KIU, MPH-CUU, 3 RD YEAR RESIDENT OBGY-KIU 19/02/2023 1 POST TERM PREGNANCY By Dr. Elioba

2. OBJECTIVES INTRODUCTION INCIDENCE ETIOLOGY DIAGNOSIS COMPLICATIONS MANAGEMENT 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 2

3. INTRODUCTION Preterm Pregnancy – Pregnancy less than 37 weeks Term pregnancy – Pregnancy between 37 -42 weeks Post Term Pregnancy - Pregnancy that extends beyond 42 wks from first day of LMP Post Date Pregnancy - Pregnancy that extends beyond 40 weeks from first day of LMP. 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 3

4. INCIDENCE The incidence of pregnancies continuing beyond 42 completed weeks (> 294 days) ranges between 4 and 14 percent. Many suspected post-term pregnancies are actually wrongly dated . Ultrasonography ( 1 st trimester scan it can help), however, in such cases, can be helpful to estimate the gestational age. When pregnancy overruns the expected date, there is risk of placental insufficiency due to placental aging. 20/02/2023 POST TERM PREGNANCY By Dr. Elioba 4

5. ETIOLOGY T he cause of the prolongation of pregnancy remain unknown. But certain factors are related with post-maturity . Wrong dates: Due to inaccurate LMP (most common) Biological variability (Hereditary) may be seen in the family Maternal factors: Primiparity, previous prolonged pregnancy, sedentary habit, elderly multipara Fetal factors: Congenital anomalies: Anencephaly → abnormal fetal HPA axis and adrenal hypoplasia → diminished fetal cortisol response Placental factors: Sulphatase deficiency → low estrogen. 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 5

6. DIAGNOSIS Menstrual history If the patient is sure about her date with previous history of regular cycles, it is a fairly reliable diagnostic aid in the calculation of the period of gestation. The suggested clinical findings when a pregnancy overruns the expected date by 2 weeks are: Weight record: Regular periodic weight checking reveals stationary or even falling weight. Girth of the abdomen: It diminishes gradually because of diminishing liquor. Obstetric palpation: H eight of the uterus, size of the foetus and hardness of the skull bones. As the liquor amnii diminishes, the uterus feels “ full of foetus ”— a feature usually associated with post maturity. 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 6

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8. RETROSPECTIVE DIAGNOSIS Baby General appearance: Baby looks thin and old. Skin is wrinkled. There is absence of vernix caseosa. Head is hard without much evidence of molding. Nails are protruding beyond the nail beds. 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. 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 8

9. COMPLICATIONS FETAL COMPLICATIONS Fetal hypoxia and acidosis Meconium aspiration Risks of cord compression due oligohydramnios. Shoulder dystocia Increased incidence of birth trauma due to non- moulding of head due to hardening of skull bones Increased incidence of operative delivery Infection Stillbirth MATERNAL COMPLICATIONS Shoulder dystocia Risk of cesarean delivery Forceps delivery Perineal lacerations PPH 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 9

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11. MANAGEMENT UNCOMPLICATED Selective induction: In this regime, the pregnancy may be allowed to continue till spontaneous onset of labor. Fetal surveillance is continued with modified biophysical profile twice a week Induction of labor reduces the rate of cesarean delivery and perinatal mortality. The timing of induction of labour start at 41+ weeks 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 11

12. MANAGEMENT If the cervix is favorable (ripe), induction is to be done by stripping of the membranes or by low rupture of the membrane s. If the liquor is found clear, oxytocin infusion is added to be more effective. Careful fetal monitoring is mandatory . If the cervix is unripe, it is made favorable by vaginal administration of PGE2 gel. This is followed by low rupture of the membranes ,Oxytocin infusion is added when required 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 12

13. MANAGEMENT COMPLICATED Elective cesarean section is advisable when post maturity is associated with high risk factors like: elderly primigravidae, preeclampsia, Rh-incompatibility, fetal compromise or oligohydramnios . Associated complications that are likely to produce placental insufficiency—Ideally pregnancy should not be allowed to go past the expected date. 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 13

14. REFERENCE DC Duttas – Textbook of Obstetrics, 8 th Edition 19/02/2023 POST TERM PREGNANCY By Dr. Elioba 14