Post-dated Pregnancy
Post-term Pregnancy
(Syn:Post-dated Pregnancy or Post maturity
Prolonged pregnancy)
• A pregnancy that has reached or surpassed 42 weeks
( 294 days ) of gestation from the first day of the last
menstrual period. ( ACOG,WHO,FIGO)
• Incidence- Range 4-19%,Average incidence-10%
Aetiology
• Wrong dates- The most common cause of
prolonged pregnancy, due to inaccurate LMP
• Hereditary- postdatism seems to run in families,
showing a genetic predisposition
• H/o previous prolonged pregnancy- recurrence
50%
• Abnormal fetal HPA and adrenal hypoplasia as in
anencephaly deficiency of dehydro-
epiandrosterone reduced fetal cortisol response.
• Placental Salphatase deficiency- this enzyme play a
critical role in synthesis of placental estrogens which
are necessary for the expression of oxytocin & PG
receptors in myometrial cells
Changes associated with prolonged pregnancy
• A series of changes occur in
-amniotic fluid
-placenta and
- fetus
Amniotic Fluid Changes
• In Postdated Pregnancy quantitative &qalitative
changes occur in Amniotic fluid
Quantitative Amniotic Fluid Changes
• Amniotic fluid peak
38wks ---- 1000ml
40wks ---- 800ml
42wks ---- 480ml
43wks ---- 250ml
44wks ---- 160ml
• After 42wks there is 33% decrease in amniotic fluid
volume/wk
• A decrease in fetal renal blood flow is associated with
postdatism is the cause of oligohydromnios
• Amniotic fluid less than 400ml is associated with fetal
complications
Method to evaluate amniotic fluid volume
• Most popular method to evaluate amniotic fluid volume is
four quadrant technique to calculate Amniotic Fluid Index
(AFI).
• AFI is obtained by measuring the vertical diameter of
largest pocket of amniotic fluid in 4 quadrants of uterus by
USG and the sum of the result is AFI
• AFI <5cm – oligohydromnios
5 – 10cm – decreased amniotic fluid volume
10 – 15cm – Normal
16 – 20cm – Increased amniotic fluid volume
>25cm - Polyhydromnios
Qualitative Changes in Amniotic fluid
• AF become milky and cloudy because of presence of
abundant flakes of vernix caseosa.
• The Phospholipids composition changes due to presence of
large number of lamellar bodies released from fetal lungs.
Vernix raises the lecithin, Sphingomyelin ratio to 4: 1 & more
• The liquor may be meconium stained as a result of
intrauterine hypoxia
Placental Changes
• USG findings:
-Indentation in chorionic plate become more marked,
giving the appearance of cotyledons
- Increased confluency of the comma- like densities
that become the inter cotyledonary septations
- Appearance of hemorrhagic infarct & Calcification
Fetal Changes
• The fetus grow in utero after term - macrosomic
which lead to fetopelvic disproportion , Prolong labor
Shoulder dystosia
• After term the fetus loses Vernix caseosa causing
wrinkling of the skin due to direct contact with aqueous
amniotic fluid
• Growth of hair and nails
• Wasting of subcutaneous tissue
Diagnosis of Postdated Pregnancy
• The diagnostic accuracy of post term pregnancy
hinges on the reliability of gestational age
• We can get accurate EDD by:-
- LMP when >3 normal regular period before LMP & no ocp
- EDD calculated by LMP coincide with EDD from USG
perform between 12-20wks
- When LMP not known EDD established from USG
between 7-11wks
- EDD corresponds to 36wks since the patient had +ve upt
- A reliable P/V finding for GA age in 1st trimester
Management
• Prior to deciding any line of action it is important to
establish the diagnosis of post term gestation by
history , examination and USG.
• Fetal Surveillance by – NST
- AFI
- Biophysical Profile
- Doppler ( Facilities available)
• Patient with Prolonged Pregnancy (>40wks) who
need to be delivered :
* Women with medical or obstetrical complications
of pregnancy
* Favorable Cervix Bishop Score > 8
* Women with oligohydromnios
* Estimated fetal weight > 4.5kg
* Suspected fetal compromise
* Fetal congenital anomaly
* Hyper mature Placenta
• Expectant management of prolonged pregnancy is
justified only when:
- GA <41 wks with unripe cervix, normal AFI ,
normal size baby , normal BPP and reactive
NST
• There is universal agreement that once pregnancy
reaches 42wks delivery mandatory – Induction/ CS
-If there is signs of fetal distress ,wt. is > 4.5kg.or
obstetrical complicated pregnancy- CS
Complication of Postdated pregnancy
Maternal – Increased morbidity due to increased
Instrumental & operative delivery
Fetal - Intrapartum fetal distress
- MAS
- Fetal trauma due to macrosomia
- Increased Perinatal morbidity & mortality
