POSTTERM PREGNANCY

By :
dr. Adhitya Maharani, SpOG

TERMINOLOGI
Postmature

: The infant with recognizable

clinical fetures indicating a pathologically
prolonged pregnancy
Postterm or Prolonged pregnancy :
expressions for extended pregnancy
Postdates : should probably be
abandoned

It

is important to realize that few

infant from prolonged pregnancies
are postmature

DEFINITION
42

completed weeks (294 days)

or more from the first day of the
last menstrual period (ACOG,
1997)

 There

is no exact method to identify

pregnancies that are truly prolonged
Incidence : 10 %
All pregnancies judge to be 42 completed
weeks should be managed as if
abnormally prolonged
Intrapartum perinatal risk is incresead,
particularly when meconium is present

POSTMATURITY SYNDROME

A characteristic :
- Wrinkled
- Patchy
- Peeling skin
- a long and thin wasting body
- serious ill due to birth asphyxia and
meconium aspiration

POSTMATURITY SYNDROME
Placental

senescence ???
In fact, the postterm fetus continues to
gain weight, although at slower rate than
at earlier gestational age and is at risk for
macrosomia

PERINATAL MORTALITY AND

MORBIDITY
INTRAPARTUM

FETAL DISTRESS
- Cord compression
- Oligohidramnion
- Prolonged/variable decelerations
IUGR/MACROSOMIA
STILLBIRTH

MANAGEMENT
ANTEPARTUM

INTERVENTION :
- Elective induction of labor
- Antepartum fetal testing
Exact timing and type of intervention ??
Cesarean section vs induction ? fetal
testing

MANAGEMENT
Intervention

at 41 versus 42 weeks ?
- Evidence : limited
- NO Randomized study : Before 42
weeks is beneficial
- In fact : intervension prior to 42 weeks
may cause some harm through
incresed cesareans without improvement
in neonatal outcome

OLIGOHYDRAMNION
Fetal

jeopardy is complicated by
oligohydramnion
The standart to use for diagnosis is not
universally agreed
Criteria USG : The largest vertical pocket
less than 1 or 2 cm, a four-quadrant AFI of
less than 5 or 6 cm or an AFI less than the
5th percentil

RECOMMENDATION
(ACOG, 1997)
1.

2.

Antenatal surveillance of postterm

pregnancies should be initiated by 42
weeks despite a lack of evidence that
monitoring improves outcome
There is insufficient evidence that
initiating antenatal surveillance between
40 and 42 completed weeks improves
outcomes

3.

4.

No single antenatal surveillance protocol

for monitoring fetal well-being in a
postterm pregnancy appears superior to
another
It is unknow whether induction or
expectant management (antenatal
surveillance) is preferable in the
postterm patient with a favorable cervix

5.

6.

There is good evidence that either

induction or expectant management will
result in good outcomes in postterm
patient with unfavorable cervices
Prostaglandin gel can be used safely in
postterm pregnancies to promote
cervical changes and induce labor

42 Completed weeks
Certain
Plus

Uncertain

Stated LMP

1. Auscultated FHR
17-20 weeks, or
2. Fundal height
between 18-30
weeks 2 cm to
LMP weeks, or
3. Ultrasound before
26 weeks

Induction of labor

Oligohydramnion ?

Decreased
fetal
movement?

Yes

No

No

Weekly visits
Induction of labor

Yes

 Labor

is a particularly dangerous time for

the postterm fetus.
FHR and uterine contractions should be
monitored
Identification of thick meconium
Management neonatus
Risk of postpatum and shoulder dystocia