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Post term pregnancy by Dr. Akebom, 2024.pptx
- 1. Post-term pregnancy Dr. AKEBOM (MD,Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 2. OUTLINE • DEFINITION • PREVALENCE •ETIOLOGY • RISK FACTORS • DIAGNOSIS • MORBIDITY AND MORTALITY • MANAGEMENT • RECURRENCE RISK • PREVENTION 2 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 3. DEFINITION • Postterm pregnancyis a gestation that has completed or gone beyond 42 weeks or 294 days from the first day of the last menstrual period .(ACOG,FIGO,WHO) • Cuttoff 42 weeks has been taken = increased risk of fetal death at 42 weeks and beyond.(early studies ) • Gestational age that warrants clinical concern should be 41 weeks.(more recent perinatal mortality data) • The timely onset of labor is an important determinant of perinatal outcome. 3 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 4. Cont... • Confusion regardingproper terminology; postmature, postdates, prolonged, postterm • Recently ACOG and SMFM have endorsed the terms below which designate gestational ages at higher risk & reduce confusion ●Postterm – ≥42+0 weeks of gestation ●Late term – 41+0 to 41+6 weeks of gestation. ●Full term – 39+0 to 40+6 weeks of gestation. ●Early term – 37+0 to 38+6 weeks of gestation. 4 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 5. PREVALENCE • Vary dependingon the population studied. • 0.4% (Austria) - 7% to 8% ( Denmark, Sweden) • These differences in incidences are the result of; (1) different approaches for managing pregnancies beyond the EDD (2) different criteria for gestational age dating 5 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 6. ETIOLOGY Mostly unknown Maternal orfetal genetic influence on the initiation of parturition Defects in fetal production of hormones involved in parturition(rare) e.g, placental sulfatase deficiency, Anencephaly 6 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 7. RISK FACTORS Previous postterm.............highestrisk (RR ≥2) Nulliparity Male fetus Obesity Older maternal age modest risk factors ( RR <2) Personal history of postterm birth Maternal ancestry (race) 7 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 8. DIAGNOSIS • Is basedon accurate gestational dating(EDD) • Commonly used methods to determine the EDD 1. Knowledge of the date of the LMP, 2. Timing of intercourse or embryo transfer, and 3. Early ultrasound assessment. • Other methods —uterine size, quickening, ability to detect fetal heart tones by Doptone, and fundal height measurement—not common 8 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 9. 1. knowledge ofthe date of the LMP • Assumes that conception occurs on the 14th day of the menstrual cycle. • The timing of ovulation varies between an individual’s menstrual cycles and between individuals • Overestimation of gestational age, and may result in a higher frequency of induction of labor for presumed postterm pregnancy. • Even with exactly recalled menstrual dates, there still is imprecision, and first- trimester sonography is the most accurate method to establish or confirm gestational age (ACOG, 2020b). 9 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 10. 2. Pregnancies Concivedby Assisted Reproduction • Fresh in vitro fertilization cycle EDD=date of egg retrieval/fertilization + 266 days • In a cycle using a frozen cleavage stage embryo (day 3 embryo) EDD = date of embryo transfer + 263 days • In a cycle using a frozen blastocyst stage embryo (day 5 embryo) EDD =date of embryo transfer + 261 days 10 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 11. 3. Early ultrasoundassessment • Superior to the use of LMP alone. • The EDD is most accurately determined = First TMX CRL measurment ( ± 5/7 days) • The EDD is considered suboptimally dated if not confirmed by an ultrasound before 22 weeks. • For twin pregnancies, if there is a discrepancy between the twins in biometric measurements, the EDD should be based on the measurements for the larger twin( consensus) 11 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 12. Reassigning EDD basedon LMP date-ultrasound discrepancy 12 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 13. MORBIDITY AND MORTALITY Manyof the complications are sequelae of either excessive fetal growth or uteroplacental insufficiency. Dysmaturity - characteristics of chronic malnutrition - 20 % posttermpregnancies - uteroplacental - cord compression - Meconium passage 13 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 14. Cont... Dysmature neonates Longthin body, long nails, and are small for gestational age Skin is dry), meconium-stained, parchment-like, and peeling; prominent creases; lanugo hair is sparse or absent, while scalp hair is increas ↑ hypoglycemia, polycythemia, perinatal asphyxia, meconium aspiration, and persistent pulmonary hypertension. They are also at risk for neurodevelopmental complications 14 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 15. Cont... • LONG-TERM NEONATALOUTCOMES Does not appear to be any difference in long-term neonatal outcome compared with term births (small and old studies, ) 15 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 16. MANAGEMENT • Accurate assessmentof gestational age is paramount in the management of late- and postterm pregnancies. • Antenatal Surveillance Studies have not shown one modality of antepartum surveillance to be superior to another At 41 weeks or beyond with assessment of amniotic fluid volume( ACOG) 16 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 17. Expectant Management VersusInduction of Labor • Induction of Labor Induction , considered for pregnancies that are between 41 0/7 and 41 6/7 weeks.(ACOG) Induction of labor after 42 0/7 weeks and by 42 6/7 weeks(ACOG) Standard cervical ripening Membrane stripping(resonable ≥ 39 weeks) - patients should be selected carefully and counseled appropriately. 17 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 18. Cont... • Expectant managementwith fetal surveillance Twice-weekly fetal surveillance beginning at 41+0 weeks Intervention if spontaneous labor does not begin by a predefined gestational age or fetal test results are not reassuring of fetal wellbeing Timing of delivery; 42+6 weeks of gestation in all pregnancies(ACOG) ≥ 43 weeks= no strong evidence on which to base a recommendation 18 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 19. RECURRENCE RISK • Afterone postterm pregnancy, the risk of a second postterm birth is increased two- to fourfold and even higher after two prior postterm pregnancies • PREVENTION Early routine ultrasound examination( decrease intervrntion by 50%) Membrane sweeping at term 19 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 20. “Simplicity is theultimate sophistication” - Leonardo da Vinci 20 Dr. AKEBOM (MD, Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)
- 21. THANK YOU 21 Dr. AKEBOM (MD,Asssistant professor of Gynecology and Obestetrics, Mekelle UniversityCollege of Health Sciences)