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Prolonged pregnancy
 

Prolonged pregnancy

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    Prolonged pregnancy Prolonged pregnancy Presentation Transcript

    • Prolonged Pregnancy By Donna Adelsperger RN, M.Ed
    • Prolonged Pregnancy
      • Gestation of 42 weeks or more
        • Term = 38 completed weeks till 41 completed weeks
      • Postmaturity refers to what happens to fetus because of prolonged pregnancy
    • Prolonged Pregnancy-Etiology
      • Cause is still unknown
      • Some evidence that initiation of labor is related to sequential changes beginning in the fetal brain that does not occur
      • There may be a placental estrogen deficiency or decreased release of prostaglandins by decidua and fetal membranes resulting in decreased stimulation to form oxytocin receptors in myometrium
    • Prolonged Pregnancy- Normal Physiology
      • Amniotic Fluid sources
        • Maternal circulation
        • Amniotic membranes
        • Fetal plasma
      • Volume changes by
        • Fetal urine
        • Fetal use of fluid for nourishment (swallowing) and it goes into GI tract
    • Prolonged Pregnancy- Normal Physiology
      • Amniotic volume gradually  to 800-1200ml by @ 34 weeks
      • AF then begins to 
      • At 40 weeks gestation level is @ 500-1000 ml
      • By 42-43 weeks levels @ 400ml
    • Prolonged Pregnancy- Normal Physiology
      • Functions of AF
        • Cushions fetus and cord
        • Allows fetus to move freely
        • Assists fetus in respiratory movements
        • Facilitates lung development and surfactant production
    • Prolonged Pregnancy- Normal Physiology
      • Placenta
        • Exchange provides large surface area for materials to be exchanged between mom and fetus
      • Functions
        • Optimal function until @ 42 weeks then aging occurs (if it has not already begun)
    • Grading the Placenta
    • Placental Grading
    • Pathophysiology
      • Amniotic Fluid
        • Oligohydramnios – below 400ml
        • Makes cord vulnerable which shuts off blood flow to and from placenta
        • Meconium in AF occurs 25 – 30% of time
          • With  AFV meconium is thick
          • Inhibits normal antibacterial properties of AF
          • Pulls fluid from Wharton jelly causing some stiffening of cord
          • So bending of cord which causes kinking and  blood flow
    • Results of Pathophysiology
      • Maternal weight loss as AF decreases
      • Decreased AF (< 400 ml) and decrease in uterine size
      • Advanced bone maturation i.e. fetal hard
        • May result in lack of molding
        • Potential for failure to progress (FTP)
        • Potential for prolonged active phase of labor
        • Potential for failure to complete transitional phase
    • Dysmaturity Syndrome
      • Occurs 1-2% of postmature fetuses
      • Skin changes occur with or without loss of subcutaneous fat, muscle mass, meconium staining depending on severity of cord compression and placental dysfunction
        • First stage-loss of vernix
        • Second stage-Green meconium stained skin and cord
        • Third stage – yellow staining of skin and cord related to old meconium. Bile in meconium turns fluid yellow.
      • Fetal hypoxia
    • Dysmaturity Syndrome
      • Meconium aspiration
      • Hypoglycemia due to anaerobic glycolysis using up CHO reserves
      • Polycythemia -  production of RBCs as compensatory response to hypoxia
        • hyperbilirubenemia
    • Pathophysiology
      • Placenta and cord
        • Aging causes fibrin and calcium deposits
        • Intervillous hemorrhagic infarcts to occur
        • Basal membrane of placental blood vessels thicken and degenerate affecting diffusion of oxygen