OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF MEDICINE BATCH 2017

OBSTETRICS
POST-TERM PREGNANCY
Lecturer: Dr. Millares (100815)

Postterm pregnancy
Conditions not wanted in patients giving birth:
-postterm or prolonged pregnancy
-postdate (not used; non-specific term)
-prolonged
-postmature (relates more to a syndrome)
Postterm, Prolonged, Postdates, Postmature
-used interchangeably to signify pregnancies that have
exceeded a duration considered to be the upper limit of normal
Postmature
-used to describe the infant with recognizable clinical features
indicating a pathologically prolonged pregnancy
Prolonged
-42 completed weeks (294 days) or more from the LMP
(ACOG) A pregnancy lasting > 2 weeks beyond the EDO
Risk Factors
Parity
Previous postterm brith
-10-27% 1 postterm birth
-39% 2 postterm birth
Socioeconomic class
Age
Incidence
-4-14% with an average of about 10%
-varies depending on several factors
Whether he calculations are based on Naegeles rule
along or whether early ultrasound in the first half of
pregnancy is used
Whether the cycle length is considered in the
calculation
Intake of durgs, especially OC pills
Presence of lactation amenorrhea
Presence of malnutrition and other medical diseases
Is the pregnancy really 42 weeks?
-those truly 42 weeks post concetion
-those with less advanced gestation due to variations in timing
of ovulation
-because there is no method to identify pregnancies that are
truly prolonged, all pregnancies judged to be 42 completed
weeks should be managed as if abnormally prolonged
Perinatal Mortality in Late Pregnancy

-all components of perinatal mortality including antepartum,

intrapartum, and neonatal deaths were increased
-main maternal risks are:
Pregnancy hypertension
Prolonged labor w/ cephalopelvic disproportion (CPD)
Postpartum hemorrhage and infection
Failed induction of labors
Operative deliveries
Perinatal Mortality
-main fetal and neonatal risks are:
Antepartum and intrapartum stillbirths
Intrauterine growth retardations
Fetal distress and hypoxia
Meconium aspiration
Shoulder dystocia and birth injuries due to fetal
macrosomia
Specific congenital malformations: anencephaly and
adrenal hypoplasia
Conditions Associated with Prolonged Pregnancy
Anencephaly
Fetal adrenal hypoplasia
Absence of fetal pituitary
Placental sulfatase deficiency
-inherited sex-linked recessive trait and that placental
hormone is produced by the fetal adrenal but lack the
hormone too convert a weak androgen to estradiol
Extrauterine pregnancy
-all of these arise from lack of increased level of estrogen

postmaturity
-3 stages of postmaturity
Amniotic fluid is clear
Skin is stained green
Skin discoloration is yellow-green
Postmaturity Syndrome
-unique and characteristic appearance
Wrkinled, patchy peeling skin
Obstetrics: Postterm Pregnancy Trans by MRPC 2015

 Long, thin body suggesting wasting and advanced

maturity
Open-eyed, unusually alert, old, and worriedlooking
Skin wrinkling on the palms ad soles
Nails are long
-many died or were seriously ill due to birth asphyxia and
meconium aspiration
Incidence
-10% 41-43 weeks AOG
-33% 44 weeks AOG
0oligohydramnios increase the incidence of postmaturity if
AFV < 1cm @ 42 weeks 88% of infants were postmature
Placental Dysfunction
-postmaturity syndrome due to placental senescence (Clifford)
-no histological evidence of placental degeneration
-skin changes were due to loss of the protective effects of
vernix caseosa
-fetus may continue to gain weight until 42 weeks
Effects on the Fetus-Infant
-continuously growing fetus may cause FPD
-oligohydramnios may develop resulting to:
cord compression (fetal distress):
Prolonged decelerations
Variable decelerations
Salutatory baseline
defecation and espiration meconium
fetal growth restriction
Presence of risk factors
-fetal factors
-maternal factors
-patient counseling and informed consent regarding definite
management option

management
Parkland Hospital Protocol

-non-delivery as long as the cervix is unfavorable for

induction
-prostaglandin E2 gel intracervically (Hannah)
Anterpartum Surveillance
-2x a week starting @ 41 weeks
a. Non-Stress Testing (NST)
b. Fetal Acoustic Stimulation Test (FAST)
c. Contraction Stress Test (CST)
d. Biophysical Profile Scoring (BPS)
e. NST + Amniotic Fluid Index (AFI)
-fetal activity, absence of acceleration, presence of
deceleration, oligohydramnios delivery
Active Induction of Labor
-initiation of the process of labor depending on the state
of the cervix, the parity of the woman and the method of
induction
-Bishop score cesarean delivery
-if with documented or suspected fetal distress CS
delivery
-in the presence of any medical or obstetrical
complication is unwise to allow pregnancy to continue
beyond 42 weeks
Intrapartum Management of Postterm Pregnancy
-when in labor, patient must be admitted to the labor
room immediately
-admission CTG test
-timing of amniotomy
Thick meconium staines AF if remote from
delivery CS delivery
If vaginal delivery is achieved after delivery of the
head effective suctioning of pharynx to prevent
aspiration
Continued Growth
-Large for Gestational Age (LGA) danger of shoulder
dystocia
Precautions regarding difficult vaginal deliveries of
poster pregnancies includes:
-fetal estimated weight > 4.5 kg
-prolonged 1st stage
-prolonged 2nd stage

-induction vs. fetal testing

Unfavorable Cervix (bishop score <7)
-40% women @ 41 weeks had undilated cervix
--END-Obstetrics: Postterm Pregnancy Trans by MRPC 2015