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Postterm or prolonged pregnancies that last 42 weeks or longer can lead to increased risks for both mother and baby. Babies may develop a postmaturity syndrome with wrinkled skin, weight loss, and other signs of aging. Risks include stillbirth and problems during labor like umbilical cord compression. Doctors recommend monitoring babies starting at 42 weeks and inducing labor if needed, especially if the mother has other complications like high blood pressure. During labor, thick meconium in the amniotic fluid can cause breathing issues for the baby after birth if not suctioned properly. Cesarean section should be considered if labor is not progressing normally.
Postterm or prolonged pregnancies that last 42 weeks or longer can lead to increased risks for both mother and baby. Babies may develop a postmaturity syndrome with wrinkled skin, weight loss, and other signs of aging. Risks include stillbirth and problems during labor like umbilical cord compression. Doctors recommend monitoring babies starting at 42 weeks and inducing labor if needed, especially if the mother has other complications like high blood pressure. During labor, thick meconium in the amniotic fluid can cause breathing issues for the baby after birth if not suctioned properly. Cesarean section should be considered if labor is not progressing normally.
Postterm or prolonged pregnancies that last 42 weeks or longer can lead to increased risks for both mother and baby. Babies may develop a postmaturity syndrome with wrinkled skin, weight loss, and other signs of aging. Risks include stillbirth and problems during labor like umbilical cord compression. Doctors recommend monitoring babies starting at 42 weeks and inducing labor if needed, especially if the mother has other complications like high blood pressure. During labor, thick meconium in the amniotic fluid can cause breathing issues for the baby after birth if not suctioned properly. Cesarean section should be considered if labor is not progressing normally.
DEPARTEMEN KEBIDANAN & KANDUNGAN FK UKRIDA Postmature - an infant with clinical features indicating a pathologically prolonged pregnancy Postterm or prolonged pregnancy - 42 completed weeks (294 days) from LMP Perinatal Mortality
Antepartum, intrapartum and neonatal deaths were increased at 42 wks and beyond. Most significant increases occurred intrapartum Major causes: pregnancy HPN prolonged labor with CPD unexplained anoxia malformations - common Postmaturity Syndrome
Stage I amnionic fluid was clear Stage II - skin stained green Stage III skin discoloration yellow-green Characteristic appearance Wrinkled, patchy peeling skin Long, thin body suggesting wasting Advanced maturity open-eyed unusually alert, old & worried-looking Long nails *Skin changes could be 2 to the loss of the protective effects of vernix caseosa *Another hypothesis attributes postmaturity syndrome to placental senescence *placental apoptosis (programmed cell death) was significantly at 41-42wks compared w/ 36-39 wks Cord plasma erythropoietin levels were significantly in pregnancies 41 wks Decreased partial oxygen pressure is the only known stimulator of erythropoietin Conclusion: there was fetal oxygenation in some postterm gestations Fetal Distress & Oligohydramnnios Intrapartum fetal distress is the consequence of cord compression associated with oligohydramnios Was NOT asso w/ LATE decel characteristic of uteroplacental insufficiency Asso w/: prolonged decel variable decel saltatory baseline (oscillations >20bpm) Consistent with cord occlusion AF common >42 wks ***fetal release of meconium into an already AF volume is the reason for the thick, viscous meconium implicated in MAS urine production was found to be asso with oligohydramnios Hypotheses: urine flow was the result of pre- existing oligohydramnios that limited fetal swallowing of AF : Fetal renal blood flow is in postterm pregnancies with oligohydramnios ACOG Recommendations for the Evaluation & Management of Prolonged Pregnancies Antenatal surveillance of postterm pregnancies should be initiated by 42wks despite a lack of evidence that monitoring improves outcomes There is insufficient evidence that initiating antenatal surveillance between 40 & 42 wks improves outcomes No single antenatal surveillance protocol for monitoring fetal well-being in post-term pregnancy appears superior to another It is unknown whether induction or expectant mgt (antenatal surveillance) is preferable in the postterm patient with a favorable cervix There is good evidence that either induction or expectant mgt will result in good outcomes in postterm patients with unfavorable cervices Prostaglandin gel can be used safely in postterm pregnancies to promote cervical changes and induce labor
In the evident of a medical or another obstetric complication, such as PIH, prior CS & DM, it is unwise to allow a pregnancy to continue past 42 wks. Timing of the delivery will depend on the individual complication. Intrapartum Management FHR & UC should be monitored electronically When to perform amniotomy? Further reduction in fluid vol enhances the possibility of cord compression May aid in the diagnosis of thick meconium Facilitates placement of a scalp electrode & intrauterine pressure catheter Thick meconium Signifies oligohydramnios Aspiration may cause severe pulmonary dysfunction & neonatal death Minimized by effective suctioning of the pharynx as soon as the head is delivered but before the thorax is delivered The likelihood of vaginal delivery is appreciably for the nulliparous woman who is in early labor w/ thick, meconium-stained AF Strong consideration should be given to prompt CS, esp when CPD is suspected or either hypo/hypertonic dysfunction is evident