postmaturity ppt for bsc nursing students

Bsc nursing

1. PROLONGED AND POST-TERM PREGNANCY (POSTMATURITY)

2. POSTMATURITY DEFINITION: Any pregnancy which has passed beyond the expected date of delivery, is called a prolonged or postdated pregnancy OR A pregnancy continuing beyond 2 weeks of the expected date of delivery (> 294 days) is called post maturity or post-term pregnancy.

3. ETIOLOGY : Factors related with postmaturity are: (1) Wrong dates —due to inaccurate LMP (most common) (2) Biological variability (Hereditary) may be seen in the family (3) Maternal factors: Primiparity , previous prolonged pregnancy, sedentary habit, elderly multiparae (4) Fetal factors: Congenital anomalies ( 5) Placental factors: Sulfatase deficiency → low estrogen.

4. DIAGNOSIS: It is indeed difficult to diagnose postmaturity when the case is first seen beyond the expected date The important dates to determine fetal gestational age are: Date of LMP; ( 2) Early ultrasound dating and ( 3) Timing of intercourse.

5. The following are the useful clinical guides: Menstrual history 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 History of false pain: Appearance of false pain followed by its subsidence Obstetric palpation: The following findings , taken together are helpful. These are : height of the uterus, size of the fetus and hardness of the skull bones. As the liquor amnii diminishes, the uterus feels “ full of fetus ”— a feature usually associated with post maturity Internal examination : A ripe cervix, Feeling of hard skull bones either through the cervix or through the fornix usually suggests maturity.

6. INVESTIGATIONS : Aims are: To confirm the fetal maturity To detect placental insufficiency Assessment of fetal maturity: Sonography : ultrasound is more accurate than LMP . This is mainly due to poor recall of LMP by most patients. Early ultrasound scan can reduce the incidence of true postmaturity Amniocentesis :

7. Criteria to establish the diagnosis of postmaturity after the birth of the baby Baby: ( 1 ) General appearance: Baby looks thin and old Skin is wrinkled Absence of vernix caseosa Body and the cord are stained with greenish yellow color Head is hard without much evidence of molding Nails are protruding beyond the nail beds ( 2) Weight often more than 3 kg (3) 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.

8. MANAGEMENT OF POSTMATURITY

9. COMPLICATIONS OF POST-TERM PREGNANCY: FETAL MATERNAL FETAL: During pregnancy — During labor — Following birth — diminished placental function oligohydramnios Meconium stained liquor. Fetal hypoxia Fetal distress. Fetal hypoxia and acidosis Labor dysfunction Meconium aspiration Risks of cord compression due to oligohydramnios Shoulder dystocia Increased incidence of birth trauma due to big size baby non-molding of head due to hardening of skull bones and Increased incidence of operative delivery . Chemical pneumonitis atelectasis and pulmonary hypertension are due to meconium aspiration Hypoxia (low Apgar scores) and respiratory failure Hypoglycemia and Polycythemia Increased NICU admissions .

10. MATERNAL: There is increased morbidity, incidental to hazards of induction, instrumental and operative delivery Post maturity per se does not put the mother at risk .

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