Prolonged pregnancy, or post term pregnancy, refers to a
pregnancy that has exceeded 294 days (42 weeks) from
the first day of the last menstrual period.
Post maturity or post mature relates to the baby and refers to
features or conditions of the neonate.
Incidence is about 6-10percent in all pregnancy.
It has been proven that the duration of pregnancy differs
depending on parity and race. Primi-288 days: Multi.-283
2. Diagnosis of postdate
Not easy to determine:
mother may give wrong dates.
clinical estimation can be inaccurate because of the
biological variation in the size of the mother and the
Quickening cannot be relied on as there is a range of
weeks i.e. primi - 15-22 weeks: multigravida 14-22
3. Diagnosis of postdate
The key to successful assessment is the date of the LMP-should be
Evaluate uterine size accurately during the first trimester.
Evaluate the uterine size during the subsequent antenatal visit.
Assess the foetal heart tone and evaluate the gestation
By ultrasound-bipariatal diameter and also the foetal length in the
X-rays –use between 35-40weeks; point of ossifications
Amniocentesis-tapping of an amount of amnioticfluid-i.e.checking
Lecithin sphyngomyelin ratio, important component of surfactant
production high at 34-35weeks.
4. Risks of Post Term Pregnancy
Prenatal mortality rates are 2-3times higher than in normal pregnancy
Postmaturity syndrome related to the aging of the
placentainfarcts placental insufficiencyFoetus will not receive
nutrients and oxygen neededhigh risk of foetal distress
reduction of amniotic fluid, which may result in cord compression
Macrosomic baby –If placental insufficiency is not there, the baby will
continue to grow to above 4kg.This causes problem during labour. e. g
Perinatal mortality rate will go up.
5. Clinical features of baby who is postdate
Has loss of subcutaneous fat i.e.when there was no
Baby has long finger nails
The causes are not known as to why the uterus has not
gone into spontaneous labour as required.
Associated factors are :-
*Anencephaly –foetal abnormality
*Lack of labour inducing factor from the foetal adrenal glands
6. Signs and symptoms of placental
After 42weeks, placenta starts to deteriorate:-
(1) static weight or loss of maternal weight.
(2) diminished amount of liquor, normal-1-1.5litres at term-
(3) reduced foetal movement felt by the mother i.e.recorded foetal
(4) abnormal foetal heart tone patterns i.e. acceleration and
(5) meconium stained liquor.
7. Complication of postdatism
*psychological-anxiety may result in depressive illness.
*prolonged labour –ineffective uterine contration
caused by CPD due to big baby.
*birth trauma to the mother
*Delivery is difficult due to ossified foetal skull bones.
8. CT Complication of postdatism
(b) Foetal complications
*placental insufficiency-affect the foetus
*intrauterine foetal dead due to hypoxia or poor supply
*foetal distress leading to c/section.
*trauma to the baby
9. Factors increasing risk
1. older primigravidae-35yrs and above.
2. poor obstetric history
4. diabetes mellitus
5. previous large baby
10. Management of prolonged pregnancy
Falls under two categories:-
*induction of labour
1.Induction of labour
should identify any other risk factors during the woman’s antenatal
Assess the foetal well being.
If the above two factors do not farvour continued pregnancy, induction
of labour is done.
Doctor will choose the method of induction
11. CT Management of prolonged pregnancy
The management of prolonged pregnancy may be
conservative in absence of complication.During the
conservative management,doctor may admit the mother.
The foetal growth is monitored by abdominal palpation and
Mother is given foetal kicks chart and she record.
Also do cardiotocography in order to check for foetal heart
12. CT Conservative management
Observe the maternal condition to rule out:-
High blood pressure
Sudden weight gain. Both of these are bad signs.
Also if psychological status is not stable.
If any foetal or maternal condition give concern, induction of
labour is done.
During labour, use continuous monitor.
If foetal distress occurs, do c/section immediately
Resuscitation of the baby is anticipated in this case.