UW late/post-term 03-24 (2)

Question 1

Late term definition?

Answer 1

≥41 weeks gestation

Question 2

Postterm definition?

Answer 2

≥42 weeks gestation

Question 3

late-term and post-term pregnancies are at increased risk for maternal and fetal complications.

Answer 3

.

Question 4

table. risk factors? 5

Answer 4

prior postterm pregnancy
nulliparity
obesity
age >=35
fetal anomalies (eg anencephaly)

Question 5

table. complications = fetal/neonatal. 4

Answer 5

macrosomia
dysmaturity syndrome
oligohydramnios
demise

Question 6

table. complications = maternal. 3

Answer 6

severe obstetric laceration
S/c
postpartum hemorrhage

Question 7

table. Mx?2

Answer 7

frequent fetal monitoring (eg nonstress test)
delivery prior to 43 weeks gestation

Question 8

table. Mx delivery when?

Answer 8

prior 43 weeks

Question 9

Maternal complications, such as postpartum hemorrhage and perineal lacerations, are due to increasing fetal growth (ie, macrosomia) associated with increasing gestational age.

Answer 9

.

Question 10

Fetal complications are due to age-related placental changes (eg, infarctions, calcifications) that result in uteroplacental insufficiency, fetal hypoxemia, and possible intrauterine fetal demise.

Answer 10

.

Question 11

!!!Signs of uteroplacental insufficiency include??2

Answer 11

late decelerations on nonstress test and/or oligohydramnios on ultrasound (ie, single deepest pocket <2 cm).

Question 12

due to fetal risk in late/post-term, what should be done frequently?

Answer 12

fetal monitoring with a nonstress test and amniotic fluid volume to evaluate for uteroplacental insufficiency.

Question 13

!!!!!why occurs oligohydramnios?

Answer 13

Oligohydramnios occurs due to uteroplacental insufficiency because fetal blood is shunted from the kidney (which produces amniotic fluid) to the brain to prevent central nervous system suppression from chronic fetal hypoxemia.

Question 14

In patients with a late-/post-term pregnancy and oligohydramnios on ultrasound OR an abnormal nonstress test, what need to do? why?

Answer 14

immediate delivery is indicated due to the risk of intrauterine fetal demise

Question 15

In case: This patient has a reactive nonstress test and vertex presentation and can therefore ……???

Answer 15

undergo an induction of labor.

Question 16

Cesarean delivery is indicated in patients with ???

Answer 16

abnormal fetal heart tracings (eg, late decelerations) or fetal malpresentation (eg, breech)

Question 17

Patients with late-/post-term pregnancies and normal amniotic fluid volume (single deepest pocket ≥2 and <8 cm) can continue routine prenatal care until ?????

Answer 17

≥42 weeks gestation.

Question 18

A biophysical profile and contraction stress test are performed to assess fetal well-being. This patient’s oligohydramnios complicating a post-term pregnancy, already meets the criteria for delivery; therefore, additional evaluation of fetal well-being is not required as it does not change management.

Answer 18

.

Question 19

An amnioinfusion is used in the management of variable decelerations, which typically occur secondary to oligohydramnios from rupture of membranes and subsequent fetal cord compression. This patient’s oligohydramnios is due to chronic placental insufficiency and has no associated variable decelerations; therefore, amnioinfusion is not indicated.

Answer 19

.

Question 20

41 w. + nonstress is normal + fundal 40 cm + cervix 1cm. The patient would like to await spontaneous labor rather than undergo an induction.
Delaying delivery to 42 weeks gestation in this patient increases the risk of which of the following pregnancy-related complications???

Answer 20

OLIGOHYDRAMNIOS

Question 21

Late- and post-term pregnancies are at risk of decreased placental function due to age-related placental changes (eg, infarctions, calcifications) that cause increased placental vascular resistance => uteroplacental insufficiency => ??

Answer 21

oligohydramnios

Question 22

uteroplacental insufficiency and chronic fetal hypoxemia, which cause central nervous system suppression and ….??

Answer 22

intrauterine fetal demise.

Question 23

Blood is preferentially distributed to the brain rather than peripheral tissue. This redistribution can be evidenced on ultrasound as oligohydramnios (single deepest pocket <2 cm or amniotic fluid index <5 cm) as amniotic fluid is dependent on renal perfusion and urine production.

Answer 23

.

Question 24

risk of uteroplacental insufficiency increases with gestational age, patients with late- and post-term pregnancies require frequent ….???2

Answer 24

fetal monitoring (eg, nonstress test, ultrasound for amniotic fluid volume).

Question 25

Patients with findings suggestive of uteroplacental insufficiency, such as late decelerations or oligohydramnios, require….?

Answer 25

delivery to prevent intrauterine fetal demise