POSTTERM PREGNANCY

IRENE MARIA ELENA

DEPARTEMEN KEBIDANAN & KANDUNGAN
FK UKRIDA
Postmature - an infant with clinical features
indicating a pathologically prolonged
pregnancy
Postterm or prolonged pregnancy - 42
completed weeks (294 days) from LMP
Perinatal Mortality


Antepartum, intrapartum and neonatal deaths
were increased at 42 wks and beyond.
Most significant increases occurred intrapartum
Major causes: pregnancy HPN
prolonged labor with CPD
unexplained anoxia
malformations - common
Postmaturity Syndrome

Stage I amnionic fluid was clear
Stage II - skin stained green
Stage III skin discoloration yellow-green
Characteristic appearance
Wrinkled, patchy peeling skin
Long, thin body suggesting wasting
Advanced maturity open-eyed
unusually alert, old & worried-looking
Long nails
*Skin changes could be 2 to the loss of the
protective effects of vernix caseosa
*Another hypothesis attributes postmaturity
syndrome to placental senescence
*placental apoptosis (programmed cell death)
was significantly at 41-42wks compared w/
36-39 wks
Cord plasma erythropoietin levels were
significantly in pregnancies 41 wks
Decreased partial oxygen pressure is the
only known stimulator of erythropoietin
Conclusion: there was fetal oxygenation in
some postterm gestations
Fetal Distress &
Oligohydramnnios
Intrapartum fetal distress is the consequence
of cord compression associated with
oligohydramnios
Was NOT asso w/ LATE decel characteristic
of uteroplacental insufficiency
Asso w/: prolonged decel
variable decel
saltatory baseline (oscillations >20bpm)
Consistent with cord occlusion
AF common >42 wks
***fetal release of meconium into an already AF
volume is the reason for the thick, viscous meconium
implicated in MAS
urine production was found to be asso with
oligohydramnios
Hypotheses: urine flow was the result of pre-
existing oligohydramnios that limited fetal swallowing
of AF : Fetal renal blood flow is in postterm
pregnancies with oligohydramnios
ACOG Recommendations for the Evaluation &
Management of Prolonged Pregnancies
Antenatal surveillance of postterm
pregnancies should be initiated by 42wks
despite a lack of evidence that monitoring
improves outcomes
There is insufficient evidence that initiating
antenatal surveillance between 40 & 42 wks
improves outcomes
No single antenatal surveillance protocol for
monitoring fetal well-being in post-term
pregnancy appears superior to another
It is unknown whether induction or expectant
mgt (antenatal surveillance) is preferable in
the postterm patient with a favorable cervix
There is good evidence that either induction
or expectant mgt will result in good outcomes
in postterm patients with unfavorable
cervices
Prostaglandin gel can be used safely in
postterm pregnancies to promote cervical
changes and induce labor



In the evident of a medical or another
obstetric complication, such as PIH, prior CS
& DM, it is unwise to allow a pregnancy to
continue past 42 wks. Timing of the delivery
will depend on the individual complication.
Intrapartum Management
FHR & UC should be monitored
electronically
When to perform amniotomy?
Further reduction in fluid vol enhances the possibility of
cord compression
May aid in the diagnosis of thick meconium
Facilitates placement of a scalp electrode & intrauterine
pressure catheter
Thick meconium
Signifies oligohydramnios
Aspiration may cause severe pulmonary
dysfunction & neonatal death
Minimized by effective suctioning of the pharynx as soon
as the head is delivered but before the thorax is
delivered
The likelihood of vaginal delivery is
appreciably for the nulliparous woman who is
in early labor w/ thick, meconium-stained AF
Strong consideration should be given to
prompt CS, esp when CPD is suspected or
either hypo/hypertonic dysfunction is evident