Post dates pregnancy

Question 1

what is early term

Answer 1

37 0/7 through 38 6/7

Question 2

what is full term

Answer 2

39 0/7 through 40 6/7

Question 3

what is late term

Answer 3

41 0/7 through 41 6/7

Question 4

what is post term

Answer 4

42 0/7 and beyond

Question 5

what are maternal risk factors for post term pregnancy (5)

Answer 5

1. Previous post term pregnancy
2. Nulliparity
3. Genetic predisposition- women born post term will likely have post term pregnancies
4. Maternal obesity
5. Advanced maternal age> 35

Question 6

what are fetal risk factors for post term pregnancies (2)

Answer 6

1. fetal abnormalities:
   - anencephaly
   - adrenal hypoplasia
   - adrenal insufficiency
2. male sex

Question 7

what are iatrogenic causes of post term pregnancy

Answer 7

errors at estimating gestational age

Question 8

how do you manage a post term pregnancy (2)

Answer 8

1. if GA is 40 weeks then do conservative management unless delivery is indicated for other reasons e.g. pre eclampsia or GA> 42 weeks
   - do cervical stretch and strip membranes at 40+ weeks if no contraindications
   - assess amniotic fluid volume with USS :
   ~ if oligohydramnios then admit for IOL
   ~ if absent fetal movements then admit for IOL regardless of fetal cardiac activity
   ~ if normal amniotic fluid volume then instruct pt to monitor fetal kick count, weekly US to monitor AFI and BPP- if normal return at 41 +3 wks gestation for IOL
2. If GA > 42 weeks then deliver via IOL or cesarean as indicated

Question 8

what investigations can you do assess post term pregnancy (2)

Answer 8

1. transabdominal USS- fetal maturity
2. non stress test (FHR) and biophysical profile ( breathing and movement)- to assess fetal well being

Question 9

what are maternal complications (5)

Answer 9

1. Labor dystocia - obstructed labor
2. Severe perineal lacerations
3. Instrumental deliveries- vacuum, forceps
4. Doubling C-Section rates.
5. Postpartum hemorrhage

Question 10

what are fetal complications (9)

Answer 10

1. Meconium aspiration syndrome- RDS
2. Post-maturity syndrome
3. Oligohydramnios- placenta may not be functioning effectively resulting in reduced blood flow and nutrient transfer which can decrease urine output- and can result in cord compression
4. Fetal demise
5. Macrosomia- can result in shoulder dystocia
6. IUGR
7. Neonatal encephalopathy- secondary to hypoxia
8. Neonatal hypoglycemia
9. Orthopedic injuries

Question 11

what are features of postmaturity syndrome (7)

Answer 11

1. Look old and appear worried.
2. Long, thin body, little body fat and muscle mass
3. Wrinkled skin especially of the soles of feet and palms, patchy and begins to peel.
4. Usually very hairy
5. Have long nails
6. Head is hard with no evidence of moulding
7. Meconium-stained yellowing of skin

Question 12

how can you prevent post term pregnancy (2)

Answer 12

1. Early ultrasound scan before 24 weeks in all pregnant women is recommended.
2. Dietary and exercise behavioral modification before or during pregnancy in obese patients.