Post Term Pregnancy Flashcards
What is post-term pregnancy?
Gestation more than 42+0
Which women are at highest risk of post term pregnancy?
Previous post term pregnancy (risk increases x2 - x4)
What are the modest RFx for post term pregnancy?
- Nulliparity
- Male foetus
- Obesity
- Older MA
- Parents post term
- Cultural background
What are the foetal and neonatal complications of post term pregnancy?
- Macrosomia
- Dysmaturity
- Perinatal mortality
What are the complications of macrosomia?
- protracted or arrested labour
- Shoulder dystocia
i. e. increased risk of birth injury
What is dysmaturity?
Syndrome of chronic intrauterine malnutrition. Foetuses are:
- long, thin and small.
- Have long nails.
- skin is dry, peeling
- meconium stained
How does perinatal mortality change with postterm pregnancy?
At 42w+ perinatal mortality is twice the rate of at term.
- 43w = 4x
- 44w = 5-7x
What are the presumed aetiologies of perinatal mortality in post-term pregnancy?
- Infection
- Placental insufficiency
- Cord compression
- Asphyxia
- Meconium
What are the maternal complications of post term pregnancy?
Sequelae or IOL, macrosomia.
- Failed IOL
- 3rd/4th degree tears
- Infection
- PPH
What are the management options for otherwise normal foetus reaching 41+0?
- IOL (41 - 42+0)
- Expectant with foetal monitoring (usually twice weekly)
Why is expectant management still a reasonable option despite a potential increase in perinatal mortality?
- Low absolute foetal death rate post term
- hence relatively high number of inductions to prevent one post term FDIU
When is induction indicated in post term pregnancy?
- Obstetrical indications
- 42 +6
