Postterm Pregnancy

Associate Professor

Iolanda Blidaru, MD, PhD.

 DEFINITION
Prolonged pregnancy
= postterm pregnancy
= postdate pregnancy
It is one that has lasted longer than
42 weeks or 294 days beyond the
first day of the last menstrual period
 Post-maturity syndrome
20 % cases of prolonged pregnancy are
associated with:
1. Meconium - stained amniotic fluid
2. Oligohydramnios
3. Fetal distress
4. Loss of subcutaneous fat
5. Cracked skin
 Etiologic Factors
The most frequent an error in dating.

When truly exists, the cause usually is

unknown.

Risk factors

Primiparity

Prior postterm pregnancy

 Etiologic Factors
Rarely, it may be associated with

placental sulfatase deficiency

fetal abnormalities (anencephaly,

adrenal hypoplasia, absence of pituitary gland).

male sex.

genetic predisposition.
 INCIDENCE

Using the definition of 294 days,

the incidence of postterm pregnancy

is 3 - 12 %.
 Fetal risks

The perinatal mortality

> 42 weeks twice that at term

> 43 weeks > 6-fold that at term

 Fetal risks
Uteroplacental insufficiency
fetal distress, hypoxia, growth restriction

Oligohydramnios - risk for cord accidents

meconium aspiration

Macrosomia - labor abnormalities, shoulder

dystocia

Sudden infant death syndrome

(death within the first year of life).

 Maternal risks
1) Labor dystocia
2) Severe perineal injury
related to macrosomia

3) Increased rate of cesarean delivery.

4) A source of anxiety for the pregnant
woman.
 DIAGNOSIS
1.Gestational age calculation

Because actual dates of conception are rarely

known, the LMP is used as the reference
point.
The accuracy determination of gestational age
unreliable because of :
1. Irregular menses .
2. Recent cessation of birth control pills.
3. Inconsistent ovulation times.
2. Routine early pregnancy ultrasound
Reduces the number of women who
require induction of labour for apparent
postterm pregnancy .
It is recommended to all pregnant
women and certainly those who do not
have regular menses, for gestational age
determination, prior to 20 weeks.
 The available evidences are
strongly in support that dating
by early ultrasonography
alone
is a very accurate method for
predicting EDD.
 3. Oligohydramnios
US diagnosis

No vertical pocket > 2 cm or

Amniotic fluid index (AFI) reduced -

considered an indication for delivery.

 Management options depend on
1) Gestational age,
2) Absence / presence of maternal risk factors
3) Evidence of fetal compromise
4) Maternal options.
Successful management depends on
effective counselling of women
and their full involvement in the
decision making process.
Management of prolonged pregnancy

a. Inducing labour routinely at 41-42

weeks gestation or
b. Awaiting the onset of spontaneous
labour, while monitoring the fetal
wellbeing.
The decision is difficult.
 FETAL SURVEILLANCE
The condition of the fetus can change
quickly monitoring at frequent
intervals.
biophysical profile
non stress test
amniotic fluid index
 BIOPHYSICAL PROFILE

1. fetal heart rate acceleration

2. fetal breathing

3. fetal active movements

4. fetal tone

5. amniotic fluid volume

 Management at 40-41 weeks gestation

A .Healthy, uncomplicated pregnancy

+ fetal growth/ amniotic fluid normal
No elective induction of labor or serial
antenatal monitoring
B. Presence of maternal risk factors or
evidence of fetal distress
Recommend cervical ripening and
induction of labour
 Management at 41 weeks gestation
A. Healthy, uncomplicated pregnancy

Inform the woman of the options and

risks/ benefits of labor induction versus
expectant management, and
offer her labor induction.
Assess the cervical (Bishop) Score and a
ripening agent (PG) prior to induction.
Management at 41 weeks gestation
B. If mother declines induction, then
provide expectant management
Daily fetal movement counts
Non stress test (NST) and Amniotic fluid
index (AFI) twice / week to 42 weeks.
If the NST or AFI is abnormal ,
then initiate induction immediately

Induce at 42 weeks
even if NST and AFI are normal.
 BISHOP SCORE
1. dilatation (cm)
2. effacement (%)
3. station
4. cervical consistency (firm,
medium, soft)
5. cervical position (posterior,
midposition, anterior)
Management during labour and delivery

Amniotomy to diagnose thick

meconium, if present risk of
meconium aspiration, continuous fetal
assessment with electronic fetal
monitoring.
Complications: shoulder dystocia and
need for neonatal resuscitation at
delivery.