Post Term

Post-term Pregnancy
DEFINITION
• Post term refers to a pregnancy that has
extended to or beyond a gestational age of
42wks or 294ds from the 1st day of the LMP
• Postdatism is pregnancy lasting beyond the
estimated due date at 40 weeks.
• Postmature specific syndrome assosciated
with post term preg in which the fetus
experiences placental insufficiency and
resultant IUGR .
Etiology
• The most frequent cause is an error in dating.
– Maternal factors : genes influence
,primiparity , irregular ovulation.
– Fetal-placental factors
- anencephaly
- adrenal hypoplasia
- X-linked placental sulfatase deficiency
⇒ A lack of the usually high estrogen levels
of normal pregnancy
-male sex
PHYSILOGICAL CHANGES ASS.
WITH POSTTERM GESTATION
• PLACENTAL CHANGES : senescence/ageing
(increased grading on ULS) infarcts ,
calcification
• AMNIOTIC FLUID CHANGES :
Oligohydramnios (diminished fetal urination)
cloudy ( vernix) presence of meconium
• FETAL CHANGES : 45%-Macrosomia
20%-IU malnutrition
Incidence: Using the definition of 294 days, the
incidence of postterm pregnancy is 10%
COMPLICATIONS
MATERNAL FETAL
• Anxiety • Fetal distress
• Traumatic vaginal • Meconium aspiration
delivery-vaginal & • Fetal trauma
perneal tear brachial plexus
• Increased CS rate injuries, clavicle
• PPH fracture
• Increased prenatal
mortality
• Dysmaturity
syndrome
MANAGEMENT
A/ CONFIRMATION OF GESTATIONAL
AGE
1.History: Reliable LMP if
Sure date
No OCP ,abortion ,lactation for the last 3 ms
Regular cycles & length of the cycle(not all
women have 28 day cycles, and not all women
ovulate on day 14 of their cycle.).
Quickening primi gravida typically notice
movement around 18-20 weeks. Mothers who
have been pregnant before notice it as early as
16 weeks.
2. Examination:
• First trimester P/V examination (ut
size goes with date)
Fundal Height : can be a rough estimate
of gestational age.
• Typically, from week 24 to week 34,
fundal height in centimetres correlates
with weeks of gestation.
• 3. FHT heard by fetoscope 18-20
wks
4- Ultrasound:
confirm or establish GA if unreliable LMP
or ut size is inconsistent with GA
First trimester CRL(+/-5d)
Second trimester BPD 12-20w (+/- 7d),20-
30(+/-2w)
• In the third trimester, the accuracy of
ultrasound in predicting the due date is less,
with a +/- confidence range of as much as 3
weeks.
B/Absence/presence of maternal & fetal
risk factors
1-Maternal diseases :-
w Diabetes.
w Hypertension \ renal diseases.
w cardiac disease.
Bad obestetrical history
2-pregnancy – related conditions:-
w pre eclampsia.
w intra hepatic choleostasis of pregnancy.
w APH at term.
3-fetal indication:-
w intra uterine growth restricted or macrosomia.
w oligohydramnious.
w Iso immunization. 9
C/Establish how favorable cervix is
(BISHOP score) & if there is contraindications
to labor or vaginal delivery)
• Previous myomectomy entering the cavity
• Fetal transverse lie
• Placenta previa
• Contracted pelvis
• Previous classical
• 2 or more CS
10
D/Assess fetal well-being
–Fetal movement counts (Not less
than 10 movement per 12 hours).
–Non stress test (Cardiotocography)
–Biophysical Profile
–Doppler Ultrasound
Management 40 wks+6d
In uncomplicated pregnancies there is no
evidence to support IOL nor fetal
surveillance if the initial assesment of fetal
wellbeing was reassuring
If there are other risk factors including HPT,

DM, IUGR, macrosomia, or oligohydramnios
 IOL or serial fetal suvillence is indicated
Management at 41 weeks gestation
A Healthy, uncomplicated pregnancy
Inducing labour at 41-42 weeks gestation

or Awaiting the onset of spontaneous labour , while
monitoring the fetal wellbeing .
Establish the cervical (Bishop) Score if faviorable
❑Inform the woman of the options and risks/ benefits

of labour induction versus expectant management,
and offer her labour induction.
Management at 41 weeks gestation
. If mother declines induction ,or un faviorable cx
then provide expectant management:
➢ Daily fetal movement counts
➢ Non stress test (NST) and Amniotic fluid index (AFI) or
BPP twice/ week to 42 weeks.
➢ If the NST or AFI is abnormal, Prostaglandin can be

used to promote cervical ripening and induce labor.
Induce at 42 weeks even if NST and AFI are

normal.
INTRAPARTUM
MANAGEMENT
• Left lateral position
• Continuous electronic fetal monitoring
• Early ARM in active phase (hastens
progress, detects meconium)
• LSCS if CPD/macrosomia, fetal distress
• Be aware of shoulder dystocia and
Paediatrician called at delivery for neonatal
resuscitation
• Post maturity syndrome
– Associated with
oligohydramnios meconium
,fetal distress & IUGR
• Wrinkled, peeling skin on
the palms and soles
• Long, thin body suggesting
wasting
• Long nails & hair
• Open-eyed, unusually alert,
old & worried-looking face
– Incidence : 20% of
pregnancies between 41and
43 weeks

Post Term

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Post Term

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Post-term Pregnancy

If there are other risk factors including HPT,

Inducing labour at 41-42 weeks gestation

Establish the cervical (Bishop) Score if faviorable

❑Inform the woman of the options and risks/ benefits

➢ If the NST or AFI is abnormal, Prostaglandin can be

Induce at 42 weeks even if NST and AFI are

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