Post Term Pregnancy

Question 1

What is post-term pregnancy?

Answer 1

Gestation more than 42+0

Question 2

Which women are at highest risk of post term pregnancy?

Answer 2

Previous post term pregnancy (risk increases x2 - x4)

Question 3

What are the modest RFx for post term pregnancy?

Answer 3

• Nulliparity
• Male foetus
• Obesity
• Older MA
• Parents post term
• Cultural background

Question 4

What are the foetal and neonatal complications of post term pregnancy?

Answer 4

• Macrosomia
• Dysmaturity
• Perinatal mortality

Question 5

What are the complications of macrosomia?

Answer 5

• protracted or arrested labour
• Shoulder dystocia
  i. e. increased risk of birth injury

Question 6

What is dysmaturity?

Answer 6

Syndrome of chronic intrauterine malnutrition. Foetuses are:

• long, thin and small.
• Have long nails.
• skin is dry, peeling
• meconium stained

Question 7

How does perinatal mortality change with postterm pregnancy?

Answer 7

At 42w+ perinatal mortality is twice the rate of at term.

• 43w = 4x
• 44w = 5-7x

Question 8

What are the presumed aetiologies of perinatal mortality in post-term pregnancy?

Answer 8

• Infection
• Placental insufficiency
• Cord compression
• Asphyxia
• Meconium

Question 9

What are the maternal complications of post term pregnancy?

Answer 9

Sequelae or IOL, macrosomia.

• Failed IOL
• 3rd/4th degree tears
• Infection
• PPH

Question 10

What are the management options for otherwise normal foetus reaching 41+0?

Answer 10

• IOL (41 - 42+0)

- Expectant with foetal monitoring (usually twice weekly)

Question 11

Why is expectant management still a reasonable option despite a potential increase in perinatal mortality?

Answer 11

• Low absolute foetal death rate post term

- hence relatively high number of inductions to prevent one post term FDIU

Question 12

When is induction indicated in post term pregnancy?

Answer 12

• Obstetrical indications

- 42 +6