Postterm pregnancy- diagnosis, management and treatment.

Question 1

what is post term pregnancy ?

Answer 1

pregnancy that has extended to or beyond 42 weeks of gestation , or estimated date of delivery (EDD) + 14 days

Question 2

etiology of post term ?

Answer 2

unknown

linked to anencephalic fetus- lack of fetal initiating factor from hypo plastic fetal adrenals

wrong due date due to miscalculated or last menstrual period = MOST COMMON

placental - dulfastase deficiency

Question 3

diagnosis of post term ?

Answer 3

important dates for fetal gestational age : date of LMP
early ultrasound dating
timing intercourse

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clinical findings
- girth of abdomen
diminishes gradually because of diminishing liquor

History of false pain: Appearance of false pain followed by its subsidence is suggestive.

Obstetric palpation: fundal height and hardness of the skull bones. As the liquor amnii diminishes, the uterus feels “full of fetus”

cervical dilation

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first trimester
US : crown rump length - more accurate than LMP
CRL in cm + 6.5 = weeks of pregnancy
Gestation sac mean diameter — ( 5-7 weeks weeks formed)

2nd trimester
US : BPD, HC, AC and FL measurement. Most accurate when done between 12 and 20
weeks (variation ± 8 days)

3rd trimester
same as US in 2nd - however less reliable
variation ± 16 days

bpp
- amniotic fluid diminishes use amniotic fluid index

INVASIVE - amniocentesis 
phophatidyl glycerol 
L/S ratio 
lamellar body count 
saturated phosphatidyl choline

Question 4

clinical management ?

Answer 4

Assesssment of fetal well being is done by twice weekly by nonstress test , biophysical profile
and ultrasonographic estimation of amniotic fluid volume

Amniotic fluid pocket < 2 cm and AFI < 5 cm indicates induction of labor or delivery.

Doppler velocimetry study of umbilical and middle cerebral arteries waveforms

doppler flow study - of placenta

closely monitor the placental detrioraration. towards the end of pregnancy calcium deposits on the walls of the blood vessels and proteins are deposited on the surface of the placenta limiting the blood flow

baby’s kick count

Doctors avoid inducing labour unless completely necessary

in labour :
forcep assistance or vacuum assistance birth
if functional narrow pelvis and fetal distress = c section

Question 5

what are the clinical findings postpartum suggesting postmaturty

Answer 5

post dysmaturity syndrome
Baby— long and thin 
minimal fat deposition
Skin is wrinkled and loose - dry peeling
little vernix and lanugo
meconium staining 
Head is hard without much evidence of molding.
Nails protruding beyond the nail beds; 
Weight  more than 3.5 kg (average) 
macrosomia (more than 4.5kg) 
thick head hair
creases cover sole

 Liquor amnii: Scanty and may be stained with meconium.

 Placenta: There is evidence of aging of the placenta manifested by excessive infarction and
calcification.

 Cord: There is diminished Wharton’s jelly which may precipitate cord compression.

Question 6

complications of post term pregnancy ?

Answer 6

perinatal mortality higher

dysmaturity syndrome - post term foetuses stop gaining weight - placenta involutes - in multiple micrinfracts and villous degeneration leading to placental insuffiecnecy - small for gestational age , undernourished with low glycogen stores
oligohydroaminos = cord compression

due to big size baby and non-molding of head due to hardening of skull bones
= shoulder dystocia , birth trauma - to mother and baby

meconium aspiration syndrome