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Management of postterm pregnancy
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Management of postterm pregnancy
In the case when the diagnosis of a pregnant pregnancy is verified (the period of 42 weeks + 1 day is established by several methods of determining the gestational age), it is necessary to solve the basic question: the timing and method of delivery for the prevention of increasing suffering (compromising) of the fetus. The solution of this question, in turn, depends on: the state of the intrauterine fetus, and on the readiness of the mother's organism for childbirth. (Fig. 175). In any case, the solution of these issues is accompanied by monitoring the condition of the fetus. It is reasonable to initiate antenatal surveillance of postterm pregnancies between 41 weeks (287 days; EDD plus seven days) and 42 weeks (294 days; EDD plus 14 days) of gestation because of evidence that perinatal morbidity and mortality increase as gestational age advances. Better to use twice-weekly testing with some evaluation of amniotic fluid volume beginning at 41 weeks of gestation. A nonstress test and amniotic fluid volume assessment (a modified BPP) should be adequate. A contraction stress test (CST) can also be done to assess fetal health and maternal. It involves giving an intravenous medication (oxytocin) to the mother to induce uterine contractions. The fetus' heart rate is monitored in response to the contractions. A fetus whose heart rate slows down during a CST may require an emergency cesarean delivery.
When determining the time and mode of delivery, it is necessary to take into account the reduced tolerance of the postterm fetus to hypoxia due to the more developed CNS and to assess the ability of the fetus to go through the labor and delivery process (the longer and stronger contractions of the uterus, during which the delivery of oxygen to the fetus is disturbed).
ACOG concludes that “Induction of labor between 41 0/7 and 42 0/7 weeks can be considered” and “Induction of labor after 42 0/7 weeks and by 42 6/7 weeks of gestation is recommended, given evidence of an increase in perinatal morbidity and mortality. ”
Management of postterm pregnancy
Fig. 175. Algorithm of management of postterm pregnancy
Post-term infant
Typical features of post-term babies are the following: dry and thin skin, absence of vernix caseosa, maceration of palms and feet, colouration of skin with meconium, thinning of umbilical cord, absence of Wharton jelly. Nails and hair are long, skull bones are hard, fontanelles are smaller in size than usually.
The main principles of management of post-term labor are as follows:
· diagnosis of postmaturity
· induction of labor pain with the help of prostaglandins, oxytocin, spasmolitic and sedative therapy;
· fetal–maternal monitoring of labor (cardiotocography, sonography);
· treatment of fetal hypoxia during labor;
· abdominal delivery by the fetal indication.
Self Test
1. Postterm pregnancy is defined as that lasting:
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A. beyond 294 days or 42 weeks' gestation:
B. beyond 41week gestation
C. from 41 to 42 weeks of pregnancy
D. From 37 completed weeks up to 42 completed weeks
2. Postterm pregnancy is more risky for
A. Mother
B. Baby
C. Both
3. Management of postterm pregnancy is dependant on:
A. accurate calculation of the pregnancy term
B. fetal condition
4. Fetal ricks in postterm pregnancy include all of the above, except of:
A. termination of pregnancy after 28 weeks but prior to the 37th completed week
B. termination of pregnancy before 38-40 weeks of gestation
5. Complications of postterm pregnancy include all from listed below except of:
A. stillbirths
B. macrosomia
C. cephalo-pelvic disproportion in labor
D. IUGR
E. fetus anemia
6. A 34-year-old woman, gravida 3, para 1, abortions 1, at 42 1/7 weeks of gestation presents to your clinic. Her NST is reactive and her cervix is 0. 5 cm dilated, 20% effaced, midposition, and firm, and the fetal vertex is at -4 station. Which of the following is the best next step in management?
A. Prostaglandin analog IV
B. Twice-weekly NST
C. Repeat modified BPP (NST and AFV)in a week
D. Cesarean section
7. The volume of amniotic fliud in true postmaturity is
A. increased
B. decreased
8. Expectant mother at 43+3days gestational term is at the active phase of the 1st stage of labor. Cervical dilatation is 5-6 cm, bag of membranes is intact, labor pains about 40-45 sec every 2-3 min. Expectant body weight of the fetus is 3. 8 kg. Fetus‘cardiac monitoring revealed intrauterine distress. What is the further management?
A. Oxygen supply
B. Augmentation of uterine contractions
C. Cesarean section.
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