POST-TERM PREGNANCY

dr. Dovy Djanas SpOG (K)

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 DEFINITION
• POSTTERM: >42 completed weeks (>294d)

• POST DATE: >40 completed weeks(280d)

• POST MATURITY: Specific syndrome of infant

associated with postterm preg

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 INCIDENCE
• BY LMP : 7.5 %
• BY USG : 2.6 %
• BY LMP + USG : 1.1 %
• Previous 1 postterm : 27 %
• Previous 2 postterm : 39 %

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 ETIOLOGY
• Wrong dates
• Biological-previous prolonged preg.
• Irregular ovulation
• Decreased fetal estrogen production
Placental sulfatase deficiency
Anencephaly
Fetal adrenal hypoplasia
• Extrauterine preg (v.v. rare)
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 PHYSILOGICAL CHANGES ASS. WITH
POSTTERM GESTATION
• PLACENTAL CHANGES : senescence/ageing (increased grading on
usg) infarcts,calcification

• AMNIOTIC FLUID CHANGES :

Oligohydramnios (diminished fetal urination) cloudy (flakes of
vernix)
L/S ratio => 4:1 presence of
meconium
• FETAL CHANGES :
45%-Macrosomia
10%-IU malnutrition

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 COMPLICATIONS
MATERNAL FETAL
• Anxiety • Fetal distress
• Traumatic vaginal • MAS
delivery-shoulder • Fetal trauma
dystocia brachial plexus injuries,
• Increased CS rate clavicle fracture
• PPH risk • Increased perinatal
mortality
• Dysmaturity syndrome

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 MANAGEMENT
CONFIRMATION OF GESTATIONAL AGE

1. Reliable LMP
Date known
No OCP for 3 mnths
Regular cycles
2. First trimester CRL(+/-7d)
3. Second trimester BPD (+/- 14d)
4. First trimester P/V examination
5. Doppler FHT 10 wks
6. Quickening 16-18 wks
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• USG
AFI <5 oligohydramnios
Macrosomia
Placental grading

• P/V examination
Assess inducibility-BISHOPS score

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 Identification of patients that need delivery

Ripe cervix
Unripe cx
Oligohydramnios
Normal fluid
Macrosomia
Normal NST/CST
Abnormal NST/BPP/CST
Normal fetal size
Meconium stained liquor

Cervical assessment,NST,AFI
DELIVERY Weekly at 40 & 41 wks
Twice wkly thereafter

Ripe cx
Oligo
Abn NST
42 WKS

DELIVERY
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 INTRAPARTUM MANAGEMENT
• Left lateral position
• Continuous electronic fetal monitoring
• CS if CPD/macrosomia,fetal distress
• Amnioinfusion (750-1000ml NS/RL) –If
meconium stained liquor,variable
deccelerations
• Paediatrician called at delivery

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 PREVENTION
Sweeping/stripping of
membranes at term if no
vaginitis,
malpresentation or
placenta praevia

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THANK YOU

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