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    9 - Postterm Pregnancy

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    Mara Medina - Borleo
    This document defines terms related to post-term pregnancy and discusses the management of post-term pregnancies. It defines a post-term pregnancy as one that persists 42 weeks or more from the last menstrual period. Risks of post-term pregnancy include postmaturity syndrome in the infant, increased perinatal mortality rates after 42 weeks, and complications like oligohydramnios, macrosomia, and medical issues in the mother. Management of post-term pregnancies involves deciding whether to induce labor or continue expectant management with fetal surveillance based on factors like cervical favorability and fetal station.

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    9 - Postterm Pregnancy

    Uploaded by

    Mara Medina - Borleo
    65 views22 pages
    This document defines terms related to post-term pregnancy and discusses the management of post-term pregnancies. It defines a post-term pregnancy as one that persists 42 weeks or more from the last menstrual period. Risks of post-term pregnancy include postmaturity syndrome in the infant, increased perinatal mortality rates after 42 weeks, and complications like oligohydramnios, macrosomia, and medical issues in the mother. Management of post-term pregnancies involves deciding whether to induce labor or continue expectant management with fetal surveillance based on factors like cervical favorability and fetal station.

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    9- Postterm Pregnancy

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    This document defines terms related to post-term pregnancy and discusses the management of post-term pregnancies. It defines a post-term pregnancy as one that persists 42 weeks or more from the last menstrual period. Risks of post-term pregnancy include postmaturity syndrome in the infant, increased perinatal mortality rates after 42 weeks, and complications like oligohydramnios, macrosomia, and medical issues in the mother. Management of post-term pregnancies involves deciding whether to induce labor or continue expectant management with fetal surveillance based on factors like cervical favorability and fetal station.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    65 views22 pages

    9 - Postterm Pregnancy

    Uploaded by

    Mara Medina - Borleo
    This document defines terms related to post-term pregnancy and discusses the management of post-term pregnancies. It defines a post-term pregnancy as one that persists 42 weeks or more from the last menstrual period. Risks of post-term pregnancy include postmaturity syndrome in the infant, increased perinatal mortality rates after 42 weeks, and complications like oligohydramnios, macrosomia, and medical issues in the mother. Management of post-term pregnancies involves deciding whether to induce labor or continue expectant management with fetal surveillance based on factors like cervical favorability and fetal station.

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    of 22

    Pos$erm

     Pregnancy  
    Defini1on  of  Terms  
    •  Postdated  pregnancy  –  not  recommended  
    •  Postmature  pregnancy    
    §  reserved  for  the  rela1vely  uncommon  specific  
    clinical  fetal  syndrome  in  which  the  infant  has  
    recognizable  clinical  features  indica1ng  a  
    pathologically  prolonged  pregnancy    
    §  Pos,erm  or  Prolonged  pregnancy  –  preferred  
    §  42  completed  weeks—294  days—  or  more  from  
    the  first  day  of  the  last  menstrual  period  
    •  The  defini1on  of  pos$erm  pregnancy  as  one  
    that  persists  for  42  weeks  or  more  from  the  
    onset  of  a  menstrual  period  assumes  that  the  
    last  menses  was  followed  by  ovula1on  2  
    weeks  later.    

    •  That  said,  some  pregnancies  may  not  actually  


    be  pos$erm,  but  rather  are  the  result  of  an  
    error  in  gesta1onal  age  es1ma1on  because  of  
    faulty  menstrual  date  recall  or  delayed  
    ovula1on.    
     
    •  These  varia1ons  in  the  menstrual  cycle  
    may  par1ally  explain  why  a  rela1vely  
    small  propor1on  of  fetuses  delivered  
    pos$erm  have  evidence  of  postmaturity  
    syndrome.    
     
    •  Sonographic  evalua1on  of  gesta1onal  
    age  during  pregnancy  has  been  used  to  
    add  precision.    
     
    Predisposing  factors  
    •  Maternal  
    §  There  are  contradictory  findings  concerning  
    maternal  demographic  factors  such  as  parity,  prior  
    pos$erm  birth,  socioeconomic  class,  and  age  as  
    risks  for  pos$erm  pregnancy.    
    §  Fetal  
    §  anencephaly,  adrenal  hypoplasia,  and  X-­‐linked  
    placental  sulfatase  deficiency    
    Perinatal  Mortality  
    •  rates  increase  aKer  the  expected  due  date  has  
    passed    
    PATHOPHYSIOLOGY  
    Postmaturity  syndrome  
    Placental  dysfunc1on  
    Fetal  distress  and  Oligohydramnios  
    Fetal  growth  restric1on  
    Postmaturity  Syndrome  
    •  wrinkled,  patchy,  peeling  
    skin  
    •  a  long,  thin  body  
    sugges1ng  was1ng    
    •  infant  is  open-­‐eyed,  
    unusually  alert,  and  
    appears  old  and  worried    
    •  skin  wrinkling  can  be  
    par1cularly  prominent  on  
    the  palms  and  soles  
    •  nails  are  typically  long  
    Postmaturity  Syndrome  
    •  the  skin  changes  of  
    postmaturity  are  due  
    to  loss  of  the  
    protec1ve  effects  of  
    vernix  caseosa    
    •  also  a$ributed  to  
    placental  senescence    
    Fetal  Distress  and  Oligohydramnios  
    •  amnionic  fluid  volume  normally  con1nues  to  decrease  
    aKer  38  weeks    
    •  both  antepartum  fetal  jeopardy  and  intrapartum  fetal  
    distress  were  found  to  be  the  consequence  of  cord  
    compression  associated  with  oligohydramnios    
    §  Prolonged  decelera1ons  
    §  Variable  decelera1ons  
    §  Saltatory  baseline  
    §  meconium  release  into  an  already  reduced  amnionic  
    fluid  volume  results  in  thick,  viscous  meconium  that  may  
    cause  meconium  aspira-on  syndrome    
    Fetal  Growth  Restric1on  
    •  S1llbirths  are  more  common  among  growth-­‐
    restricted  infants  delivered  aKer  42  weeks    
    COMPLICATIONS  
    Oligohydramnios  
    Macrosomia  
    Medical  or  Obstetrical  Complica1ons  
    Oligohydramnios  
    •  Regardless  of  the  criteria  used  to  diagnose  
    oligohydramnios  in  pos$erm  pregnancies,  
    most  inves1gators  have  found  an  increased  
    incidence  of  some  sort  of  “fetal  distress”  
    during  labor    
    Macrosomia  
    •  The  American  College  of  Obstetricians  and  
    Gynecologists  (2013b)  has  concluded  that  current  
    evidence  does  not  support  induc>on  of  women  
    at  term  with  suspected  fetal  macrosomia.    
    §  vaginal  delivery  is  not  contraindicated  for  women  
    with  an  es1mated  fetal  weight  up  to  5000g  
    §  Cesarean  delivery  is  recommended  for  es1mated  fetal  
    weights  greater  than  4500g  if  there  is  prolonged  
    second-­‐stage  labor  or  arrest  of  descent.    
    Medical  or  Obstetrical  Complica1ons  
    •  In  the  event  of  a  medical  or  other  obstetrical  
    complica1on,  it  is  generally  not  recommended  
    that  a  pregnancy  be  allowed  to  con1nue  past  
    42  weeks.    
    §  gesta1onal  hypertensive  disorders,  prior  cesarean  
    delivery,  and  diabetes    
     
    MANAGEMENT  
    The  decision  centers  on  whether  labor  induc1on  is  warranted  or  if  
    expectant  management  with  fetal  surveillance  is  best.    
     
    Prognos1c  factors  for  successful  induc1on  

    •  Favorability  of  cervix  


    §  Bishop  score  >9:  favorable  for  induc1on  
     
    •  Sta1on  of  vertex  
    §  the  higher  the  sta1on  is  at  the  1me  of  labor  
    induc1on,  the  higher  the  rate  of  Cesarean  delivery  
    Induc1on  vs  Fetal  Tes1ng  
    •  there  is  insufficient  evidence  to  recommend  a  
    management  strategy  between  40  and  42  
    completed  weeks.    
    •  although  not  considered  mandatory,  ini1a1on  
    of  fetal  surveillance  at  41  weeks  is  a  
    reasonable  op1on    
    •  aKer  comple1ng  42  weeks,  recommenda1ons  
    are  for  either  antenatal  tes1ng  or  labor  
    induc1on  
    Induc1on  vs  Fetal  Tes1ng  
    •  Fetal  Tes1ng  
    §  fetal  movement  coun1ng  
    §  NST  2-­‐3x/week  
    §  amnio1c  fluid  volume  determina1on  2-­‐3x/week  
    Intrapartum  Management  
    •  Monitor  FHR  and  UCs  electronically  
    •  Role  of  amniotomy?  (has  both  +  and  –  effect)  
    §  Further  reduc1on  in  fluid  volume  can  enhance  the  
    possibility  of  cord  compression  
    §  Amniotomy  aids  iden1fica1on  of  thick  meconium  
    Intrapartum  Management  
    •  Thickly  meconium-­‐stained  AF  
    §  aspira1on  may  cause  severe  pulmonary  dysfunc1on  
    and  neonatal  death  
    §  amnioinfusion  during  labor  has  been  proposed  as  a  
    way  of  dilu1ng  meconium  to  decrease  the  incidence  
    of  aspira1on  syndrome    
    §  ACOG:  amnioinfusion  does  not  prevent  meconium  
    aspira>on,  however,  it  remains  a  reasonable  treatment  
    approach  for  repe11ve  variable  decelera1ons    
    §  for  the  nulliparous  woman  who  is  in  early  labor  with  thick,  
    meconium-­‐stained  amnionic  fluid  and  remote  from  delivery,  
    strong  considera1on  should  be  given  to  prompt  cesarean  
    delivery    

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