POSTTERM PREGNANCY - PowerPoint PPT Presentation

About This Presentation
Title:

POSTTERM PREGNANCY

Description:

POSTTERM PREGNANCY AZZA ALYAMANI OBSTETRICS & GYNICOLOGY Department King Khalid University Introduction Post term pregnancy is a common situation. – PowerPoint PPT presentation

Number of Views:2590
Avg rating:3.0/5.0
Slides: 24
Provided by: azza4
Category:

less

Transcript and Presenter's Notes

Title: POSTTERM PREGNANCY


1
  • POSTTERM PREGNANCY
  • AZZA ALYAMANI
  • OBSTETRICS GYNICOLOGY
  • Department
  • King Khalid University

2
  • Introduction
  • Post term pregnancy is a common situation.
    It
  • cause anxiety for both women and obstetricians
  • because it perceived as being a cause of
    increased
  • risk to the fetus.
  • Post term pregnancy per se is not a
    pathological
  • condition and should not be confused with the
  • post maturity syndrome described by Clifford in
  • 1954.

3
  • Definitions

4
  • Post term ( prolonged pregnancy )
  • it is 42 completed weeks or more ( 294
    days).
  • this definition is accepted by both WHO
    FIGO.
  • Post maturity syndrome
  • it is IUGR with associations of
    ,meconium
  • stained amniotic fluid ,
    oligohydramnios , fetal
  • distress , loss of subcutaneous fat and
    dry
  • cracked skin reflecting placental
    insufficiency.
  • Past date
  • past the calculated EDD before 42
    weeks.

5
(No Transcript)
6
  • Incidence
  • 5 -10
  • Dating by the last menstrual period (LMP)
    alone ,
  • has a tendency to overestimate the GA .
  • While the use of early ultrasound alone , to
    calculate
  • GA , significantly reduced the incidence of post
    term
  • pregnancy . Ia

7
  • Importance
  • Fetal and Neonatal risks
  • It is likely that the majority of
    morbidity and mortality associated with post
    term pregnancy, arises because of post maturity.
  • Post term pregnancies are
    associated with excess perinatal morbidity
    mortality .
  • Delivery at 42 week is associated
    with a doubling of the perinatal mortality rate ,
    unlike
  • the 37 -41 week period in which antepartum
  • deaths contribute about 2/3 of the total .

8
  • When lethal congenital abnormalities
    are
  • excluded ,intrapartum fetal death is 4 times
    more
  • common, and
  • neonatal death is 3 times more
    common in infant s born after 42 weeks.

9
  • In addition , meconium staining of the
    amniotic
  • fluid and the likely of intrapartum fetal
    hypoxia
  • were much more common in post term
  • pregnancies compared to those delivered at 40 ws.
  • This result in fetal acidosis , neonatal
    seizures
  • perinatal death . Post term pregnancy is also a
  • risk factor for birth trauma and shoulder
    dystocia.

10
  • B) Maternal risks of post term pregnancies
  • increased operative delivery , hemorrhage
    and
  • maternal infection.
  • in addition , psychological morbidity as
  • increased maternal anxiety .

11
  • Etiology
  • Not Clear
  • It is common in
  • primigravida
  • previous post term
    pregnancy. 30
  • The cause may be due to
  • 1. low cortisol levels with post term fetal
    distress.
  • 2. relative adrenocortical insufficiency leading
    to
  • delay in the onset of labor increased risk
    of
  • intrapartum hypoxia or death.

12
  • Support for this theory is that
  • infants delivered following a post term
    pregnancies
  • are at increased risk of
  • sudden infant death syndrome.
  • death up to 2 years of age.

13
Fetal Assessment
14
  • Monitoring Post term Pregnancy
  • The perinatal mortality does not
    significantly rise
  • until 42 ws. gestation ,thus there is no need to
    offer
  • fetal monitoring prior to this gestation, if it
    is not
  • offered at term .
  • There is no consensus about the
    appropriate
  • surveillance to post term pregnancy and no clear
  • evidence exists to support that fetal monitoring
  • can reduce the perinatal mortality.

15
  • simple fetal monitoring is as effective as
    more
  • sophisticated monitoring of post term
    pregnancies
  • The use of Doppler analysis of various
    arterial
  • systems as uterine , umbilical ,middle
    cerebral
  • and descending aorta in uncomplicated post
    term
  • pregnancies is not different from that in
    term
  • pregnancies.

16
  • Therefore
  • the recommended fetal monitoring
  • in post term pregnancy
  • is

17
  • a) Amniotic fluid measurement
  • Liquor volume fall after term , thus
    AFI does
  • not improve perinatal outcomes , thus the mean
  • pool depth (MPD) is the tool of choice for
    monitoring
  • liquor in post term pregnancy. Ib
  • b) CTG
  • Simple monitoring with NST and
    liquor assessment holds an advantage over the
    formal
  • biophysical profile scoring.

18
  • It is therefore ,vital that each woman is
    treated
  • on an individual basis and counseled regarding
  • the risks of post term pregnancy.

19
  • Management

20
  • (1) induction of labor at 41 weeks
  • to reduce perinatal mortality , meconium
    staining
  • of the amniotic fluid and small decrease
    in
  • caesarean section rate . 1a
  • (2) conservative management
  • with close fetal surveillance, this can
    reduce
  • excess operative delivery in women who
    will
  • opt to for conservative management .

21
  • Other interventions
  • a. nipple stimulation
  • but have not been shown to be of benefit .
  • b. sweeping the membranes
  • at or beyond 40 weeks appear to
    significantly
  • reduce the incidence of post term
    pregnancy
  • and should be offered to all women.

22
  • Key points
  • 1. the use of early ultrasound dating ,
    reduces the
  • incidence of postterm pregnancy.
  • 2. induction of labor after 41 weeks
    reduces perinatal
  • mortality rates without increasing
    CS rates.
  • 3. sweeping the membranes significantly
    reduces the
  • incidence of postterm pregnancy .
  • 4. no clear evidence that fetal monitoring
    can reduce the
  • perinatal mortality in postterm
    pregnancy.
  • 5. the use of NST and liquor assessment
    in monitoring
  • postterm pregnancy twice weekly is
    recommended in
  • women who prefer conservative
    management with
  • fetal surveillance.

23
THANK YOU
Write a Comment
User Comments (0)
About PowerShow.com