Post Dates Pregnancy

Last updated 10.12.13

 

Definition

-  Prolonged pregnancy: pregnancy >42/40 gestation

 

Features

-  IOL at 41/40 reduces LUSCS rate without compromising perinatal outcome

-  Less intrapartum fetal compromise, MSL & macrosomia

-  Incidence 5-10% of pregnancies

- Risk of perinatal death increases from 1:7,00 at 36/40 to 1:350 at 42/40

 

Risk Factors For Stillbirth

-  Age >40yrs

- BMI >30

- IUGR

-  Smoker

- RFM

- DM/GDM

- HTN/Pre-eclampsia

 

Complications

-  IOL

- Assited delivery or LUSCS

- Chorioamnionitis

- Laour dystocia

- Perineal tears (due to macrosomia)

- Intrapartum fetal compromise

- Neonatal morbidity: MSL, acidaemia, birth injury, stillbirth

- Macrosomia

- Congenital malformations

 

Ix

- Fetal monitoring

-  Twice weekly CTG from 41/40  

-  +/- US: AFI, SD  

 

Mx

- Prevention

-  Correct dating  

- Ensure correct dating of pregnancy

-  Stretch & Sweep

-  Offer at 40/40  

- Consider after 38/40

-  IOL

-  If low risk aim for 41+3/40 to 42/40

- If indicated by fetal monitoring

-  If high risk as per indication: +/- 38/40+

 

 

 

References

 

SA Governement: Prolonged Pregnancy, January 2012