postdates pregnancy Flashcards
late term vs post term
late term: 41w0d - 41w6d
post term: 42w0d and beyond
postterm pregnancy prevalence in US
about 5.5%
risk factors identified for postterm pregnancy
nulliparity, prior postterm pregnancy, carrying a male fetus, and maternal obesity. also likely genetic factors.
fetal risks of postterm pregnancy
increased risk of neonatal convulsions, meconium aspiration syndrome, and 5-minute Apgar scores of less than 4. increased risk of NICU admission. increased risk of postmaturity syndrome. twofold increased risk of macrosomia. more frequent incidence of oligohydramnios. increased risk of stillbirth!
maternal risks of postterm and late-term pregnancy
severe perineal laceration, infection, postpartum hemorrhage, and cesarean delivery
most common cause of late or postterm pregnancy
inaccurate dating
management of late and postterm pregnancy
offer induction at 41 weeks, recommend at 42 weeks. can also offer membrane sweeping if mother thinks induction is too “aggressive”
antenatal testing for late and postterm pregnancy
No large RCTs have compared different modalities of fetal surveillance in late-term and postterm pregnancies. But you can offer once or twice weekly BPPs and/or NSTs (better data for twice weekly than once weekly) starting at 41 weeks. If oligohydramnios is identified (SDP < 2 cm instead of getting an AFI), delivery is recommended!
