post term px chalie..................pptx

post term px chalie..................pptx

• 1.
  Category X • Studiesin animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
• 2.
  …. • Example drugs:atorvastatin, simvastatin, finasteride thalidomide, oral contraceptives, misoprostol, valproate ,Methotrexate ,Ribavirin, Triazolam, Bosentan, Aliskiren, Emergency contraception, Levonorgestrel, Ulipristal.
• 3.
  Post term pregnancy Definition:A pregnancy that has been beyond 42 weeks of gestation(294 days or EDD+14days) from the first day of LMP Definition is endorsed by ACOG, FIGO & WHO Increased perinatal morbidity & mortality Increased maternal morbidity & mortality
• 4.
  Prevalence  4-14%, averageis 10% Prevalence varies depending on: • Use of U/S for GA determination • Primi Vs multi • Using LNMP • Elective C/D • Pregnancy complications • 2 -7% of pregnancies complete 43 weeks
• 5.
  Etiology • Mechanism ofnormal labor not known, thus cause of prolonged pregnancy remains obscure. • When post term pregnancy truly exists, the cause is unknown Common causes: • Wrong date: poor recall or variation in follicular phase • Biologic variability: hereditar
• 6.
  … • Fetal factors:Anencephaly • Placental factor: sulfatase deficiency • Maternal factors: Primigravida, past prolonged pregnancy, elderly multiparity
• 7.
  Fetal & Maternalrisks • Fetal risks are usually associated with small fetuses and maternal complications are due to macrosomic fetuses ( 2x term macrosomia) Fetal risks: • Increased perinatal mortality: twice than at term and four times at 43 weeks & 5-7X at 44 wks or above • Uteroplacental insufficiency • Meconium aspiration • Macrosomia: associated with prolonged labor, CPD& shoulder dystocia
• 8.
  • Dysmaturity syndrome:10 - 20 % of post term pregnancies • Manifestation of chronic IUGR due to placental insufficiency • wrinkled , patchy peeling skin • long, thin body (wasting) • open eyed, alert • old and worried looking • Long nails
• 9.
  Complications of dysmaturity syndrome •Increased fetal heart beat abnormalities • Meconium aspiration • Umblical cord compression • Short term complications: hypoglycemia, seizure, respiratory insufficiency • Long term complications: neurologic sequaele.
• 10.
  … • Metabolic complications:hypoglycemia, • hypocalcemia, polycythemia MATERNAL RISKS: Increased Maternal morbidity due to: • Induction • Instrumental delivery • Cesarean delivery
• 11.
  Effects are: • Dystocia •Severe perineal injury with macrosomia • Increased C/S delivery –doubled • Puerperal infection, PPH • Anxiety
• 12.
  Diagnosis • Estimation ofaccurate gestational age is mandatory by available best methods. • Clinical estimation of gestational age is inferior than ultrasound • LNMP is inaccurate in 10-40% of cases because of irregular ovulation, oligomenorrhea & unable to recall LNMP • LNMP is helpful when the menstrual cycle is regular.
• 13.
  … • The diagnosisof truly prolonged and post-term pregnancy is based on accurate gestational dating. • The two most commonly used methods to determine the GA are : (1) knowledge of the date of the LMP, (2) early ultrasound assessment • Basing gestational age solely on the LMP generally results in an overestimation of gestational age => higher frequency of induction of labor
• 14.
  Gestational Age Calculation ACOGcriteria: • Urine/ serum hcG positive first: 36 weeks has to lapse • FHB positive 1st : by Doppler (30 weeks),pinnards (20wkS) • Ultrasound: 1s trimester(CRL) 2nd Trimester(BPD, AC, FL) • Biochemical: L/S, lecithin/sphingomyelin, lamellar count, shake test etc…
• 15.
  Investigations Purpose of investigation: Toconfirm fetal maturity To detect evidence of placental insufficiency Assessment of maturity • Ultrasound/ ACOG criteria • Amniocentesis
• 16.
  Assessment of fetalwellbeing: • Fetal kick count by mother • NST- twice weekly • BPP • Amniotic fluid volume • Doppler studies of umbilical arteries
• 17.
  Management • Be certainabout maturity of fetus • Expectant or induction • In expectant management, start antepartum testing at 41 weeks twice weekly • Induce at 42 weeks if cervix is favorable or by priming • Induce/ terminate pregnancy if ante partum tests are non reassuring • Terminate the pregnancy at 43 weeks irrespective of the cervical status.
• 18.
  Care during labor •More use of analgesics • Consider possibility of shoulder dystocia • Strict fetal monitoring
• 19.
  Prevention • Accurate datingby early ultrasound: decreased incidence by 70% • Manual nipple stimulation at term • Electrical breast stimulation • Sweeping of membranes near or at term.