Postterm Pregnancy

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APGO educational topic number 30 post
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term pregnancy post term pregnancy is
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defined as reaching or extending beyond
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42 weeks estimated gestational age the
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incidence of post term pregnancy in the
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United States is 5.5 percent in this
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video we will review how perinatal
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morbidity and mortality increase with a
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prolonged pregnancy the objectives of
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this video are to identify the normal
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duration of pregnancy list the
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complications in prolonged gestation and
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describe the evaluation and
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evidence-based management options for
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prolonged gestation remember that we
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date pregnancies using menstrual dating
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the estimated date of delivery is
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calculated as 40 weeks past the first
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day of her last menstrual period late
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term pregnancy is defined as one that
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has reached between 41 and 0 days and 41
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and 6 days a post term pregnancy is
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defined as beyond 42 weeks the most
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common cause of post term pregnancies is
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inaccurate estimation of gestational age
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the patient’s LMP date can accurately
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predict the EDD if she has regular
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28-day cycles ultrasound helps more
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accurately determine the EDD when used
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in conjunction with LMP dating the
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morbidity and mortality risk for both
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mother and fetus increased with post
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term pregnancy maternal risks include
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increased risks of maternal vaginal
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trauma and cesarean delivery cesarean
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delivery increases the risk of infection
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bleeding thromboembolic event and
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visceral injury fetal risks include
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increased risk of macrosomia post
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maturity syndrome meconium aspiration
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syndrome and a loggerhead romeo’s
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macrosomia increases the risk of
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operative vaginal delivery cesarean
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delivery and shoulder dystocia
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macrosomia is defined as an infant
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greater than 4,500 grams and it occurs
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in two to ten percent of post term
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pregnancies post maturity syndrome is
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associated with an aging placenta it
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complicates 10 to 20 percent of post
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term pregnancies these fetuses have
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decreased subcutaneous fat and lack
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vernix and lanugo the incidence of
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meconium passage increases as
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pregnancies become prolonged and this
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leads to an increased risk of meconium
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aspiration syndrome
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meconium aspiration syndrome can lead to
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severe respiratory distress from
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mechanical obstruction of both small and
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large Airways as well as meconium
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chemical pneumonitis Alico Hydra meiosis
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rates increase with prolong
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pregnancy’s remember that the fetus will
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always try to protect blood flow to the
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fetal brain when the fetus senses
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decreased placental flow it will deep
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prioritize blood flow to the kidneys in
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order to preserve blood flow to the
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brain
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this results in decreased urine
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production the rates of intrauterine
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fetal demise increase after 41 weeks
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estimated gestational age let’s move on
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to interventions first and foremost
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there should be accurate assessment of
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gestational age ultrasound measurements
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should be used to confirm the estimated
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date of delivery membrane sweeping has
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been associated with a decreased risk of
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late term and post term pregnancies in
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this procedure an OB provider gently
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sweeps the amniotic sac away from the
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uterine wall at the level of the cervix
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and/or lower uterine segment although
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this procedure is uncomfortable for
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patients it can release prostaglandins
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that increase the chance of spontaneous
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labor antepartum fetal surveillance
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should be initiated at 41 weeks given
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the increased risk of intrauterine fetal
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demise and finally induction of labor
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should occur between 41 and 42 weeks
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estimate of gestational age this
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concludes the aapko video on post term
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pregnancies we reviewed a normal
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pregnancy duration the importance of
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obtaining an accurate assessment of the
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estimated due date and reviewed
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interventions for trying to decrease the
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morbidity and mortality associated with
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post term pregnancies