Prolonged Pregnancy

By

Prof Farouk Abdel Aziz
What is it ?
Wrigley 1958 :
There can no more be an exact time for
gestation than an exact height or an exact
weight for everyone
Postmaturity - prolonged
Pregnancy
Increased perinatal mortality

Balantyne (1902)
The postmature infant can with difficulty
be born alive
Definition

FIGO (1982) and WHO define prolonged
pregnancy as a pregnancy lasting 42
completed weeks or more =294+ days
Diagnosis of PP
History :
LMP Quickening FH Size of uterus.
Investigations :
-hCG
-US GS,CR,at 12 ws CR is not accurate
more is BPD ,head circumference ,femur length
-Amniotic fluid samplingfoetal fat cells
creatinine ,lethecin/sphengomelin ratio
Aetiology
Seasonal variation longer in summer 2-5
days
Improved living standards
Heridatory and racial factors
Placental aging
Unknown
Significance of PP
Foetal implications :
Increased perinatal mortality
Intrapartum foetal distres
Neonatal implications
Maternal Implications :
-Anxiety to parents
-Increased CS rate
at term CS rate = 13.6
in PP CS rate = 25.6

Management
This is the most controversial area in
obstetrics
Gibard intervention involved jumping
from the frying pan of postmaturity into
the fire of induction of labour

Induction at term
Antenatal Surveillance

Clinical assessment of foetal growth :
Abdominal palp. Size, oligohydramnios,
foetal movements
Biophysical assessment ;
Amniotic fluid by US
Foetalmovements
Breathing
Tone
Reactivity
- Doppler US examination


AN Surveillance continued
Biochemical assessment:
Human placental lactogen
Limited value
Intrapartum Care :
electronically monitored

Prolonged Pregnancy
END