《妇产科学》课程教学课件（PPT讲稿）6.2 Postterm pregnancy

Postterm pregnancy Luo Xiaodong 1

1 Postterm pregnancy Luo Xiaodong

Definition prolonged pregnancy,post-dated pregnancy Pregnancy that has reached 42 weeks(294 days)of completed gestation from the first day of the last menstruation or 40 weeks'gestation from the time of conception. Menstrual cycle is normal 28~30 days The frequency of postterm pregnancy is 5~10% 3

2 Definition prolonged pregnancy, post-dated pregnancy Pregnancy that has reached 42 weeks(294 days) of completed gestation from the first day of the last menstruation or 40 weeks’ gestation from the time of conception. Menstrual cycle is normal 28~30 days The frequency of postterm pregnancy is 5~10%

Etiology is not known,maybe correlate to fetal adrenal cortex Surmise the mechanism for the initiation of delivery has some abnormalities PG (prostaglandin)and E deficient,P increase Fetal malformation 3 Anencephalic fetus,hypoplasia of adrenals 3

3 Etiology  is not known, maybe correlate to fetal adrenal cortex Surmise the mechanism for the initiation of delivery has some abnormalities  PG（prostaglandin） and E deficient, P increase Fetal malformation  Anencephalic fetus, hypoplasia of adrenals

Pathology Placental function is sufficient (90%) Fetus growth,macrosomia,shoulder dystocia Skull calcified Placental function is insufficient 3 Three stage 3 Postmaturity syndrome(PMS):infants are withered,meconium-stained,fragile,with long nails and peeling skin Placenta:thinner,infarcts,fibrin deposition and calcification 4

4 Pathology Placental function is sufficient (90%)  Fetus growth, macrosomia, shoulder dystocia  Skull calcified Placental function is insufficient  Three stage  Postmaturity syndrome(PMS): infants are withered, meconium-stained, fragile, with long nails and peeling skin  Placenta: thinner, infarcts, fibrin deposition and calcification

Complication Perinatal morbidity rates increased sharply Fetal distress meconium aspiration syndrome(MAS),asphyxia Trauma:shoulder dystocia Mental retardation and neurologic sequelae Mother: 3 manipulative delivery is increased

5 Complication Perinatal morbidity rates increased sharply  Fetal distress  meconium aspiration syndrome(MAS), asphyxia  Trauma: shoulder dystocia  Mental retardation and neurologic sequelae Mother:  manipulative delivery is increased

Diagnosis and Treatment I.Dating the pregnancy Date the LMP Positive Serum HCG at 5 weeks Fetal heart tones auscultated with a stethoscope at 18~20 weeks,with electronic device in 10 weeks Physical exam of uterus:height of fundus, 8 Maternal perception of quickening Ultrasound:crown-rump length,diameter of BPD (biparietal diameter) 6

6 Diagnosis and Treatment 1. Dating the pregnancy  Date the LMP  Positive Serum HCG at 5 weeks  Fetal heart tones auscultated with a stethoscope at 18~20 weeks, with electronic device in 10 weeks  Physical exam of uterus: height of fundus,  Maternal perception of quickening  Ultrasound: crown-rump length, diameter of BPD (biparietal diameter)

2.Evaluation of the fetus A kick count:normal fetal movement >10beats/12h 8 Electronic fetal monitoring:NST,CST,2~3 times weekly 8 Ultrasound evaluation biophysical profile)BPP: twice weekly,8 in normal,<5 is oligohydramnios,twice weekly Check for meconium in the amniotic fluid:greenish

7 2. Evaluation of the fetus  A kick count:normal fetal movement 10beats/12h  Electronic fetal monitoring: NST, CST, 2~3 times weekly  Ultrasound evaluation ( biophysical profile) BPP: twice weekly, 4 abnormal  Ultrasound measurement of the amount of amniotic fluid: AFI( amniotic fluid index)>8 in normal, <5 is oligohydramnios, twice weekly  Check for meconium in the amniotic fluid: greenish

3.Termination of pregnancy 8 Baby in danger:NST nonreactive,OCT or CST positive,abnormal biophysical profile Cervix ripe Fetal weight >4000g or FGR Other severe complication:eclampsia 3 oligohydramnion 8

8 3. Termination of pregnancy  Baby in danger: NST nonreactive, OCT or CST positive, abnormal biophysical profile  Cervix ripe  Fetal weight >4000g or FGR  Other severe complication: eclampsia  oligohydramnion

Vaginal delivery Cervical ripen:artificial rupture of fetal membrane Cervical unfavorable:use medicine to make it ripen Cesarean section Cervix is unfavorable Inducing labor is failed Fetal distress 3Dystocia:fetopelvic disproportion 9

9 Vaginal delivery  Cervical ripen: artificial rupture of fetal membrane  Cervical unfavorable: use medicine to make it ripen Cesarean section  Cervix is unfavorable  Inducing labor is failed  Fetal distress  Dystocia: fetopelvic disproportion

Summary Gestation >41 weeks Fetal movement ↓ NST nonreactive CST positive Biophysical profile<6 Amnionic fluid AFI<5 Induced Vaginal CS delivery 10

10 Summary Gestation >41 weeks Fetal movement Amnionic fluid CST positive Biophysical profile<6 NST nonreactive Induced Vaginal CS delivery AFI<5