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P OSTTERM PREGNANCY. D EFINITIONS infant with recognizable clinical feature indicating...
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Transcript of P OSTTERM PREGNANCY. D EFINITIONS infant with recognizable clinical feature indicating...
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POSTTERM PREGNANCY
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DEFINITIONS infant with recognizable clinical feature
indicating pathologically prolong pregnancy
Post term or prolong pregnancy: >42weeks(294 days) from LMP
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INCIDENCE4-14% (AVERAGE = 10%)
Recurrence if one previous postterm birth =2
if two previous postterm birth =39%
if mother had postterm the risk in daughter
increased 2-3 fold
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Perinatal mortality: Antepartum , intrapartum and neonatal death increases mostly intrapartum
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MAJOR CAUSES
Pregnancy Hypertension Prolong labor with CPD Unexplained anoxia Meconium aspiration Asphyxia
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Early neonatal seizure:
Postterm = 5.4/1000Term = 0.9/1000
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Anencephaly Adrenal hypoplasia
Lack of estrogen elevation
Prolonged pregnancy
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POSTMATURITY SYNDROME
Three stages:1- Clear amniotic fluid2- Green stained skin3- Yellow-green skin discoloration
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Wrinkled, patchy peeling skin Long , thin body Open-eyed Unusually alert, old and worried-looking Wrinkling mostly on palms and soles Nails typically long
Most of these are not growth restricted
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SO: Many died Many are seriously ill Many are brain damaged - Birth Asphyxia -Meconium aspiration
Incidence : 41- 43 weeks 10% At 44 week 33%
Due to:
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PLACENTAL DYSFUNCTION
No degeneration or morphological changePlacental apoptosis (but clinical significance
unclear) Cord plasma erythropoietin (Due to low fetal oxygenation)
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FETAL DISTRESS AND OLIGOHYDRAMNIOS Oligohydramnios
Cord compression
Meconium in amniotic fluid
Meconium aspiration
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MANAGEMENT Interventions are indicated in prolonged
pregnancy : Which and when are controversial
41 or 42 weeks ?
Induction or expectant management?
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At 41 week: - Induction if cervix is favorable
- Fetal testing if cervix is unfavorable
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At 42 week: - Induction if cervix is favorable
- Induction or fetal testing if is unfavorable
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Cervical dilatation
Is important prognostic factor for induction success
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UNFAVORABLE CERVIX PG gel can be used for cervical ripening
Mifepristone (RU486) did not stimulated uterine activity
Sweeping or stripping of membranes at 38-40 weeks decreased postterm pregnancy
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No change the risk of C/S Nochange in maternal and neonatal infection
Painful Might provoke vaginal bleeding Irregular uterine contractions
Membranes stripping
but could be
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Many clinician prefer to employ fetal testing to avoid induction
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FETAL TESTINGFetal movement over 2hour/each
dayNST 3 times/weekAmniotic fluid volume 2-3times/week
pocket< 3cm is abnormal
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When amniotic fluid is normal ,no guarantee for fetal well being
But When amniotic fluid is decreased,The fetal is at risk
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If no vertical pocket > 2cm or AFI< 5 cm
Either delivery or close fetal surveillance
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Doppler velocimerty was not
recommended
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1st induction
42 completed wks
certain uncertain
2nd induction
3ed induction versus C/S
Oligohydramnios?3days later Fetal movement?
Yes YesNoNo
weekly visit
induction of labor
in parkland hospital
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INTERAPARTUM MANAGMENT
Admission as soon as suspected are in labor
Electronic monitoring of fetal heart and contraction
When to perform amniotomy is problematic Presence of thick meconium is worrisome
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Aspiration of thick meconium may cause severe pulmonary dysfunction and neonatal death
so:Suction the pharynx when head is delivered
and before delivering of thorax
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IDENTIFICATION OF THICK MECONIUM:
When pregnant is remote from delivery
So:C/S must be considered especially
If :CPD or hypotonic, hypertonic
dysfunctionis evident
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Some clinician avoid oxytocin use in this cases
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Postterm fetus may be LGA and shoulder dystocia may develop
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