Powerpoint Presentation on Post Maturity.pptx

Gynaecological

1. WELCOME Dr. Aklima Akter Assistant Professor ( Gynae ) Sheikh Hasina Medical College, Tangail 13.11.2019

2. POST MATURITY(POST TERM PREGNANCY) Definition : A pregnancy continuing beyond two weeks of the expected date of delivery or beyond 42 wks. Etiology : Mostly unknown but following are the related factors: Wrong dates: Due to inaccurate LMP calculation. Biological or hereditary variability may be seen in the family Maternal factors: Primiparity , Previous prolonged pregnancy Fetal factors: Congenital anomalies like anencephaly Placental factors: Sulphatase defficiency causes low level of estrogen

3. DIAGNOSIS Clinical diagnosis: BY M/H Suggestive clinical findings- Wt record, abdominal girth and internal examination. But these are not so reliable. USG- BPD, FL and CRL in early USG are the most reliable measurements. Amniocentesis- invasive procedures of biochemical and cytological parameters are not done in every aspects.

4. DIAGNOSIS Retrospectively after birth of the baby the following criteria has been used to dx the post maturity: Baby- looks thin and old, skin is wrinkled, absence of vernix caseosa , head is hard, nails are protruding beyond the nail beds. Liquor amnii -Scanty and may be stained with mwconium Placenta-Evidence of ageing of the placenta manifested by excessive infarction and calcification. Cord- Diminished quantity of Wharton’s jelly which may cause compression.

5. COMPLICATIONS FETAL: During pregnancy: Diminished placental function, oligohydramnios and meconium stained liquor leads to fetal hypoxia and fetal distress. During labor : Fetal hypoxia and acidosis Meconium aspiration Risk of cord compression due to oligohydramnios Shoulder dystocia

6. COMPLICATIONS (v) Increased incidence of birth trauma due to big size baby (vi) Non moulding of the head due to hardening of the skull bones (vii) Increased incidence of operative delivery Following birth : Chemical pneumonitis, atelectasis and pulmonary hypertension due to meconium aspiration. Hypoxia and respiratory failure Hypoglycaemia and polycythaemia Increased perinatal morbidity and mortality

7. MANAGEMENT UNCOMPLICATED GROUP: Induction is preferable if the cervix is favourable COMPLICATED GROUP: Caesarean section is preferable if any complications like CPD, PE, APH, DM, Rh negative patient and presence of placental insufficiency.

8. PRETERM BABY DEFINITION: A baby born before 37 completed weeks of gestation calculating from the 1 st day of last menstrual period. Manifestations of prematurity: Usually the weight is <2500 gm and the length is <44cm Head and abdomen are relatively large Skull bones are soft with wide sutures and posterior fontalle Head circumference disproportionately exceeds that of the chest. Pinnae of ears are soft and flat

9. Manifestations of prematurity Eyes are kept closed The skin is thin, red and shiny due to lack of subcutaneous fat and covered by plentiful lanugo and vernix caseosa . Muscle tone is poor Plantar creases are not visible before 34 wks Testicles are undescended Labia minora are exposed due to labia majora are not in contact Nails are not grown right upto the finger tips

10. COMPLICATIONS Asphyxia Hypothermia Pulmonary syndrome- Pulmonary edema, Intra-alveolar haemorrhage , RDS Cerebral haemorrhage Infection due to poor response of both humoral and cellular immunity Jaundice due to hepatic insufficiency Dehydration and acidaemia due to immature renal function. Anaemia Retinopathy of prematurity – multi factorial

11. MANAGEMENT PRINCIPLE: Prevention of prematurity Management of pre term labor Care of the pre term baby after birth

12. PRINCIPLES FOR THE CARE OF THE PRE TERM BABY To maintain body temperature To maintain adequate ventilation To prevent infection To maintain nutrition and adequate nursing care

13. Care of the pre term baby To maintain body temperature : As the premature babies are extremely thermolabile , they can easily develop hyperpyrexia or hypothermia. The rectal temperature should be between 96 -99 F Respiratory support: Clear the air passage and administer 0 2 . Continuous 0 2 monitoring is done by pulse oximeter .

14. CARE OF THE PRETERM BABY To prevent infection: Prophylactic antibiotic should be given to prevent respiratory, GIT, skin and umbilical infection Nutrition : Preterm babies are often unable to suck and swallow, so NG tube feeding may require. Sometimes parenteral feeding may necessary when situation demands. Early feeding with colostrum within 1-2 hours after birth and continuation of mothers milk is ideal.

15. CARE OF THE PRETERM BABY Adequate nursing : Temperature Should be taken twice daily and the baby should be weighed daily to know whether over or under hydrated. Constant supervision specially during the crucial first 48 hours is imperative. Mother should be allowed to attend her baby Mother is taught for the general care of the baby and manual expression of breast milk

16. FAVOURABLE SIGNS OF PROGRESS Color of the skin remains pink all the time Smooth and regular breathing Increasing vigour evidenced by movements of the limbs and cry. Progressive gain in weight( baby looses weight 1-2% every day for the first 5-7 days. Thereafter gain 1-1.5% of birth weight daily. Baby regain birth weight by 10-14 days)

17. WHEN TO DISCHARGE When baby attain sufficient weight Attain good vigour Able to suck breast milk successfully

18. ADVICE ON DISCHARGE Advice about feeding schedule To attend the child specialist for subsequent checkup, immunization and guidance.

19. THANK YOU