Post term pregnancy

Question 1

When is a pregnancy considered post term?

Answer 1

42 weeks or more
- affects 10% of pregnancy

Question 2

What are the causes of post term pregnancy?

Answer 2

• idiopathic
• congenital malformation (anencephaly)
• young primigravida
• pre pregnancy BMI > 25
• maternal genes

Question 3

What are the risks of post term pregnancy on the mother?

Answer 3

• pre eclampsia
• fetal macrosomia -> perineal lacerations
• postpartum hemorrhage
• oligohydramnios
• caesarian delivery

Question 4

What are the risks of post term pregnancy on the fetus?

Answer 4

• shoulder dystocia
• still birth
• post-maturity syndrome
• NICU admission
• HIE
• neonatal convulsions
• meconium aspiration (meconium indicates fetus distress)
• birth injuries
• infection
• childhood obesity

Question 5

What are the indications for immediate induction?

Answer 5

1- reduced amniotic fluid on scan
2- reduced fetal growth
3- reduced fetal movements
4- cardiotocography is not perfect
5- medical comorbidity (hypertension)

Question 6

What will happen to placental function in case of post term pregnancy?

Answer 6

• declines due to aging & infarction -> leads to perinatal morbidity
• oligohydramnios can lead to umbilical cord compression, -> fetal compromise & C section

Question 7

How is will labour be induced in post term pregnancy?

Answer 7

• depending on Bishop score
• Prostaglandin: PGE1 or PGE2
• membrane sweeping
• C section in case of abnormal fetal surveillance

Question 8

How is post term pregnancy managed?

Answer 8

fetal surveillance should be done twice weekly
41 weeks & 7 days
- if uncomplicated -> fetal surveillance, membrane sweeping, labour induction
- if complicated (HTN, oligohydramnios) -> labour induction
- 42 weeks & 7 days -> labour induction