1. PROLONGED
PREGNANCY(POSTDATISM)OR
POSTERM
 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
foetus.
 Quickening cannot be relied on as there is a range of
weeks i.e. primi - 15-22 weeks: multigravida 14-22
weeks.

3. Diagnosis of postdate
 The key to successful assessment is the date of the LMP-should be
accurate.
 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
first trimester.
 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
placentainfarcts  placental insufficiencyFoetus will not receive
nutrients and oxygen neededhigh 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
 Birth trauma
 C/section
 CPD/Shoulder dystocia
 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
placental sufficiency
 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
 *extrauterine pregnancy

6. Signs and symptoms of placental
deterioration
 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-
800mls.
 (3) reduced foetal movement felt by the mother i.e.recorded foetal
kicks.
 (4) abnormal foetal heart tone patterns i.e. acceleration and
deceleration.
 (5) meconium stained liquor.

7. Complication of postdatism
 (a) maternal.complications
 *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
of nutrition.
 *foetal distress leading to c/section.
 *meconium aspiration
 *trauma to the baby

9. Factors increasing risk
of Postdatism
 1. older primigravidae-35yrs and above.
 2. poor obstetric history
 3. pre-eclampsia
 4. diabetes mellitus
 5. previous large baby

10. Management of prolonged pregnancy
 Falls under two categories:-
 *induction of labour
 *conservative management
 1.Induction of labour
 should identify any other risk factors during the woman’s antenatal
clinic visit.
 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
 2.Conservative management
 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
ultrasound.
 Mother is given foetal kicks chart and she record.
 Also do cardiotocography in order to check for foetal heart
activity.

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.
Note
 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.