Post on 18-Jan-2018
description
POST-TERM POST-TERM PREGNANCYPREGNANCY
Dr.Mona ShroffDr.Mona Shroff
11Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info
DEFINITIONDEFINITIONPOSTTERM: >42 completed weeks POSTTERM: >42 completed weeks
(>294d) (>294d)
POST DATE: >40 completed POST DATE: >40 completed weeks(280d)weeks(280d)
POST MATURITY: Specific syndrome POST MATURITY: Specific syndrome of infant associated with postterm of infant associated with postterm preg preg 22Dr. Mona Shroff Dr. Mona Shroff
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INCIDENCEINCIDENCEBY LMP : 7.5 %BY LMP : 7.5 %BY USG : 2.6 %BY USG : 2.6 %BY LMP + USG : 1.1 %BY LMP + USG : 1.1 %Previous 1 postterm : 27 %Previous 1 postterm : 27 %Previous 2 postterm : 39 %Previous 2 postterm : 39 %
33Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info
AETIOLOGYAETIOLOGYWrong datesWrong datesBiological-previous prolonged preg.Biological-previous prolonged preg. Irregular ovulationIrregular ovulationDecreased fetal estrogen productionDecreased fetal estrogen production Placental sulfatase deficiencyPlacental sulfatase deficiency AnencephalyAnencephaly Fetal adrenal hypoplasiaFetal adrenal hypoplasiaExtrauterine preg (v.v. rare)Extrauterine preg (v.v. rare)
44Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info
PHYSILOGICAL CHANGES PHYSILOGICAL CHANGES ASS. WITH POSTTERM ASS. WITH POSTTERM
GESTATIONGESTATION PLACENTAL CHANGESPLACENTAL CHANGES : senescence/ageing : senescence/ageing
(increased grading on usg) (increased grading on usg) infarcts,calcificationinfarcts,calcification
AMNIOTIC FLUID CHANGESAMNIOTIC FLUID CHANGES : : Oligohydramnios (diminished fetal urination) Oligohydramnios (diminished fetal urination)
cloudy (flakes of vernix) cloudy (flakes of vernix) L/S ratio => 4:1 L/S ratio => 4:1
presence of meconium presence of meconium FETAL CHANGESFETAL CHANGES : :
45%-Macrosomia45%-Macrosomia 10%-IU malnutrition10%-IU malnutrition
55Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info
COMPLICATIONSCOMPLICATIONSMATERNALMATERNAL
AnxietyAnxiety Traumatic Traumatic
vaginal delivery-vaginal delivery-shoulder shoulder dystociadystocia
Increased CS Increased CS raterate
PPH riskPPH risk
FETALFETAL Fetal distressFetal distress MASMAS Fetal traumaFetal trauma brachial plexus brachial plexus
injuries, clavicle injuries, clavicle fracturefracture
Increased Increased perinatal perinatal mortalitymortality
Dysmaturity Dysmaturity syndromesyndrome
66Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info
MANAGEMENTMANAGEMENT CONFIRMATION OF GESTATIONAL AGECONFIRMATION OF GESTATIONAL AGE
1. Reliable LMP1. Reliable LMP Date knownDate known No OCP for 3 mnthsNo OCP for 3 mnths Regular cyclesRegular cycles2. First trimester CRL(+/-7d)2. First trimester CRL(+/-7d)3. Second trimester BPD (+/- 14d)3. Second trimester BPD (+/- 14d)4. First trimester P/V examination4. First trimester P/V examination5. Doppler FHT 10 wks5. Doppler FHT 10 wks6. Quickening 16-18 wks6. Quickening 16-18 wks
77Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info
USG USG AFI <5 oligohydramniosAFI <5 oligohydramnios MacrosomiaMacrosomia Placental gradingPlacental grading
P/V examinationP/V examination Assess inducibility-BISHOPS Assess inducibility-BISHOPS
scorescore88Dr. Mona Shroff Dr. Mona Shroff
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Identification of patients that need delivery
Ripe cervixOligohydramnios
MacrosomiaAbnormal NST/BPP/CST
Meconium stained liquor
Unripe cxNormal fluid
Normal NST/CSTNormal fetal size
Cervical assessment,NST,AFIWeekly at 40 & 41 wksTwice wkly thereafter
Ripe cxOligo
Abn NST42 WKS
DELIVERY
DELIVERY99
Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info
INTRAPARTUM INTRAPARTUM MANAGEMENTMANAGEMENT
Left lateral positionLeft lateral positionContinuous electronic fetal monitoringContinuous electronic fetal monitoringEarly ARM in active phase (hastens Early ARM in active phase (hastens
progress, detects meconium)progress, detects meconium)LSCS if CPD/macrosomia,fetal distressLSCS if CPD/macrosomia,fetal distressAmnioinfusion (750-1000ml NS/RL) –If Amnioinfusion (750-1000ml NS/RL) –If
meconium stained liquor,variable meconium stained liquor,variable deccelerationsdeccelerations
Paediatrician called at deliveryPaediatrician called at delivery1010Dr. Mona Shroff Dr. Mona Shroff
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PREVENTION PREVENTION Sweeping/stripping Sweeping/stripping
of membranes at of membranes at term if no term if no vaginitis, vaginitis, malpresentation malpresentation or placenta or placenta praeviapraevia
1111Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info
THANK YOUTHANK YOU
1212Dr. Mona Shroff Dr. Mona Shroff www.obgyntoday.infowww.obgyntoday.info