Final- Post Term Pregnancy

Question 1

Post term pregnancy

definition

Answer 1

pregnancy of 42 weeks or beyond

Question 2

synonym for prolonged pregnancy? what does it imply?

Answer 2

• post maturity
• presence of placental insufficiency and the need for the induction of labor
• post dates DOES NOT equal post maturity

Question 3

what’s the risk with post term pregnancy?

Answer 3

neonatal mortality and stillbirth rates are 3X higher (due to placental failure)

Question 4

what are the 3 classifications for post term pregnancy?

Answer 4

• Incorrect dates or abnormal menstruation
• Correct dates, but physiological maturity is 42-43 weeks rather than 40 weeks; or fertilization has not occurred at normal time (late ovulation).
• True Post Dates Pregnancy: Dates are correct, physiological maturity is 40 weeks, but labor fails to occur (20-30%). This is the group where the majority of placental insufficiency occurs where the fetus is hypoxic and at risk of intrauterine death.

Question 5

what are some changes seen with inadequate placental function (signs of growth retardation)

Answer 5

• diminished amniotic fluid level
• possible meconium stained fluid, therefore possible staining of the skin of the baby
• dry and peeling skin
• absence of subcutaneous fat on infant (usually longer than normal length and underweight)
• umbilical cord shows loss of Wharton’s jelly
• placenta often more calcified and/or more stained
• shrinkage of internal organs – the heart and liver due to loss of glycogen reserves

Question 6

most common cause of post term pregnancy?

Answer 6

-failure of cervix to soften (ripen)

Question 7

other causes of post term pregnancy?

Answer 7

• high doses of aspirin or other prostaglandin inhibitors (prohibit cervical ripening)
• lack of oxytocin
• progesterone block by placenta
• anencephaly (unlikely to ever have labor)
• lack of stimulus to the cervix and lower segment by the presenting part (malpresentation, occipitoposterior position, short umbilical cord)
• extrauterine pregnancy if PG is very prolonged and resists induction
• psychological factors

Question 8

MD management of post term pregnancy?

Answer 8

induce at 41 weeks, 42 or 43 depending on your source (could be 40 too)

Question 9

ND management of post term pregnancy?

Answer 9

• weekly US after 41 weeks
• fetal movement counts, must have started before 40 weeks for comparison
• consider induction if signs of mature placenta, diminished amniotic fluid, or other signs the fetus is being compromised.
• take into account other pregnancy lengths, and labor difficulties
• assess ripening cervix, position of baby, etc

Question 10

what does ND induction entail?

Answer 10

• prostaglandin gel- put inside the cervix
• intercourse- semen incr prostaglandins
• castor oil- incr prostaglandins
• herbs - blue and black cohosh
• nipple stimulation- breast pump or nursing baby
• acupuncture- sacral points with electrical stimulation to the needles (very popular)
• AROM to rupture membranes