Postmaturity (Prolonged Pregnancy)

Postmaturity (Prolonged Pregnancy)

Definition 

Pregnancy is said to be prolonged when it staysmore than the normal duration. There is no definite accepted duration that can be regarded as normal but when pregnancy exceeds 294days (42weeks) as calculated from the 1st day of the last menstruation pregnancy is said to be prolonged because actual date of conception is not certain and not all fetuses mature at the same number of days. It occurs in about 10% of all pregnancies.

Causes

Unknown, but sometimes it runs in families. It may be related to race and geographical locations.

Effect on Mother

·              Has additional risk to those with obstetrical complications e.g. Hypertension eclampsia e.t.c

·              Predisposed to traumatic delivery -- Cesarean section, forceps and vacuum deliveries

Effect on the Fetus:

1.           Placental insufficiency

2.           Fetal distress resulting from fetal acidosis

3.           Ossification of the skull bones – leading to less m oulding and traumatic delivery.

4.           Perineal death

5.           Still birth

Diagnosis

1.           By calculation from the last menstruation period.

2.           Scrutiny of Ante Natal record to monitor fetal growth

3.           First day of quickening is considered

4.           Ultrasound – to assess size of the head

5.           X-ray to see ossification of the lower femoral epiphysis (36wks) and upper tibia epiphysis (at term)

6.           diminished liquor amni

Management

1.           Each case is dealt with according to its special circumstances

2.           Rule out case Cephalopelvic Disproportion (CPD)

3.           Admission is necessary

4.           Induction with Artificial Rupture of membrane (ARM) and Oxytocin

5.           Caesarean Section: it is complicated by pre-eclampsia, infertility, elderly primp, oligohydramios, fetal distress and failed induction (by 6hrs)

6.           Prostaglandin E₂ gel can be injected into the extra uterine space or posterior Vaginal wall to ripen the cervix. This may be followed by another dose.

7.           Forceps delivery may be necessary in second stage.

Midwives Role:

1.           Ascertain expected delivery date ,Refer to Doctor at the

2.           ANC

3.           In labor – careful monitoring of fetus, fetal heart Rate Contractions

4.           Vital Signs during induction

5.           The woman should lie on her side

6.           Reassurance the woman.

Characteristics of Post matured Baby

1.           Hard skull bones, small fontanelles and narrow sutures

2.           Loose, dry and cracked skin

3.           Long nails.