post term pregnancy in obg nursing.pptx

Obg

1. Post –term pregnancy RESHMI R 4 th year Bsc nursing

2. Definition *Literally, any pregnancy which has passed beyond the expected date of delivery, is called prolonged pregnancy or post dated pregnancy. By clinical purpose, a pregnancy continuing beyond 2 week of the expected date of delivery (>294days)is called post maturity or post-term pregnancy. -WHO.

3. ETIOLOGY *Wrong dates-mainly due to inaccurate LMP. *Maternal factors-primiparity,previous prolonged pregnancy, sedentary habits, elderly multipara. *Fetal factors – Congenital anomalies:: Anencephaly  abnormal fetal hPA axis and adrenal hypoplasia diminished fetal cortisol response.

4. *Biological variability (hereditary)may seen in the family. *Placental factors -Sulfatase deficiency low estriol. *Genetic factors –Mother who herself was post-term has the high risk for post-term pregnancy.

5. Clinical concepts The following criteria have been used to establish the diagnosis of post maturity retrospectively.i.e after the birth of the baby. Baby-post maturity syndrome. *Baby looks thin and old. *wrinkled skin, palms and soles. *wasting of muscles. *less subcutaneous fat.

6. *Absence of vernix caseosa.
*body and cord are stained greenish yellow color.
*Head is hard without much evidence of molding.
*Nails are protruding beyond the nail beds. -weight :>3kg. -length :54cm.

7. * Placenta : there is evidence of ageing of the placenta manifested by excessive infraction, apoptosis and calcification. * liquor amnii :Scanty and may be stained with meconium. * cord :There is diminished quantity of Wharton’s jelly which may precipitate cord compression.

8. DIAGNOSIS It is indeed difficult to diagnose post maturity when the case is first seen beyond the expected date. >The important dates to determine fetal gestational age are: *Date of LMP. *Timing of intercourse. *Early pregnancy ultrasound dating. *Date of embryo transfer.

9. >The following are the useful clinical guides: 1.menstrual history 2.The accuracy of gestational age measured by the CRL in the first trimester based on LMP is superior to LMP alone. 3.The suggested clinical findings when a pregnancy overturns the expected date by 2 weeks are: *weight record. . *Girth of the abdomen. . *Obstetrical palpation –uterus feels ‘full of fetus’. . * Internal examination –ripening of the cervix.

10. INVESTIGATION Aim:*To confirm the fetal maturity. . *To detect the placental insufficiency. >sonography >Amniocentesis >Daily fetal monitoring count. >Modified biophysical profile. >Doppler velocimetry.

11. Complications >Fetal complications *During pregnancy: -Diminished placental functions. -oligohydraminos. -meconium stained liquor. -fetal hypoxia and fetal distress -IUFD.

12. During labour: -fetal hypoxia and acidosis. -labor dysfunction. -meconium aspiration. -Risk of cord compression due to oligohydramnios. -shoulder dystocia - increased incidence of birth trauma. - increased incidence of operational delivery.

13. >Maternal complications: -Dysfunctional labour. -Prolonged labour. -Fetopelvic disproportion. -Birth injury. . -Oligohydraminos and cord compression effect. -maternal morbidity and mortality.

14. Following Birth: *chemical pneumonitis,atelectasis, pulmonary hypertension. *hypoxia . *Hypoglycemia . *increased chance of NICU admission. *Increased neonatal convulsions. *Birth injuries. *Perinatal morbidity and mortality.

15. MANAGEMENT Prevention . *First trimester ultrasound to confirm the EDD. . *Antenatal fetal surveillance. . * Timely delivery may reduce the risk of still birth.

16. The formulation of management grouped into two : * uncomplicated. *Complicated. >uncomplicated group: M easures to assess the fetal risk of post dated pregnancy. . *DFMC . *Non stress test(NST). *USG measurement for amniotic fluid volume. . *Biophysical profile. . *Induction and delivery is to be done with any evidence of fetal compromise.

17. >selective induction: In this regimen, the pregnancy may be allowed to continue till spontaneous onset of labour. Fetal surveillance is continued with modified BPP. >Routine induction: The expectant attitude is extended for 7-10days past the expected date and thereafter labour is induced.

18. >INDUCTION: The induction of labour is mostly cnsidered beyond 41 weeks of gestation. It reduces the rate of cesarean delivery and perinatal mortality. ° if the cervix is favorable (ripe) : induction is to be done by stripping of the membrane or by low rupture of the membrane. °If the liquor is clear, oxytocin infusion is added if required. °careful fetal monitoring is mandatory.

19. If the cervix is unripe (Bishop score<6): It is made favorable by vaginal administration of PGE2 gel. This is followed by the low rupture of membrane. Oxytocin is added if required.

20. >Complicated group: -Elective cesarean section is advisable when post maturity is associated with high risk factors.

21. Nursing management Teach the daily fetal monitoring count antenatally. Ongoing FHR assessment for signs of cord compression in labour. Take conservative action for cord compression due to oligohydramnios: change position, Amnioinfusion,O2. Careful monitoring of labour progressions. Provide emotional support.