POST TERM PREGNANCY MANAGEMENT

POST-TERM PREGNANCY
Definition:
Sometimes it is called postmaturity or postdates.
Post-dates pregnancy is any pregnancy which extends beyond the womans due date. True post-term pregnancy is defined by the World Health Organization as a pregnancy of 42 completed weeks (294 days) or more, although the term is more and more often used to refer to any pregnancy that goes beyond 41 weeks.
Complications
The prolongation of pregnancy (≥42 weeks) has been associated with increased Perinatal Mortality rates. Other obstetrical and perinatal complications that are found to be higher in post-term pregnancies include fetal distress, non-progression, operative delivery (both operative vaginal and Caesarean), macrosomia, shoulder dystocia, low Apgar scores, and meconium aspiration.

Etiology:
Unknown, but hereditary, hormonal and non-engagement of the presenting part are suspected factors.
It could also be wrong dates especially if the woman cannot recall her LNMP.

Diagnosis:
History:
Calculation of gestational age by using her last normal menstrual period (LNMP)
1st or 2nd trimester Obstetric Ultrasound (USS done before 20 weeks of gestation)
Determine the time of fetal quickening. Most of times quickening may start at around 16-18 weeks.
Fundal height between X and Y at Booking

Examination: larger baby size.  
Ultrasonography: can detect,
Biparietal diameter more than 9.6 cm.  
Increased foetal weight.  
Oligohydramnios.  
Increased placental calcification. 

Management
Delivery is indicated whenever post-term pregnancy is confirmed. But induction of labour has to be preceded by doing a BISHOP score for favorability of the cervix. Cervix is said to be favorable for induction if the BISHOP score is >6.
Induction of labour if the condition is favorable for vaginal delivery using:
Ripening the cervix by using intracervical catheter under traction ballooned with 30-40 mls of water for injection.
Ripening the cervix by using 25µg of Misoprostol 6hrly in 24hrs inserted in the posterior fornix can be used BUT misoprostol is not licensed for Induction of labor in Tanzania by TFDA.
Amniotomy ± oxytocin.
For Primegravida: 5IU Oxytocin in 500mls of D5% or Lactated Ringers 
For grandmultiparous women: 2.5IU oxytocin in 500mls of D5% or Lactated Ringers 
Caesarean section: if conditions are not favorable for vaginal delivery, or if induction of labour failed.

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