Post term infant

1. POST TERM
INFANTS

2. DEFINITION
ETIOLOGY
MORBIDITY ASSOCIATED WITH POST TERM PREGNANCY
POST MATURITY SYNDROME
MANAGEMENT

3. DEFINITION
 INFANTS BORN AFTER 42 WEEKS OF GESTATION
(294 DAYS ) OR MORE
 OVERALL MORBIDITY AND MORTALITY OF
POSTTERM INFANTS IS 3 TIMES HIGHER THAN
TERM

4. INCIDENCE INCIDENCE OF POSTTERM INFANTS IS 4-14 %
AVERAGE IS 10%

5. ETIOLOGY
 UNKNOWN
 INACCURATE DATING
 BIOLOGICAL VARIABILITY ( HORMONAL FACTORS AND GENETIC
PREDISPOSITION)

6.  MATERNAL FACTORS
o PRIMIPARITY & ELDERLY MULTIPARAE
o OBESITY ( low BMI - PRETERM PREGNANCY)
o PREVIOUS PROLONGED PREGNANCY
o IRREGULAR MENSTRUAL CYCLE

7. FETAL FACTORS
 MALE FETUS
 ANENCEPHALY
 TRISOMIES 13 AND 18
 SECKEL SYNDROME ( BIRD HEADED DWARFISM)
 FETAL ADRENAL INSUFFICIENCY AND FETAL ADRENAL HYPOPLASIA

8.  PLACENTAL FACTORS
 Altered levels of circulating hormones , that play role in spontaneous labour
 Placental sulphatase deficiency - is a rare X-linked recessive disorder that can
prevent spontaneous labour due to a defect in placental sulphatase activity and
the resulting decreased estriol levels (E3)

9. PATHOPHYSIOLOGY
 Abnormal fetal hypothalamic pituitary adrenal axis as in anencephaly ,
deficiency of dehydroepiandrostenedione , reduced cortisol response
 Placental sulphatase deficiency - critical role in synthesis of placental
estrogens , necessary for the expression of oxytocin and PG receptors in
myometrial cells

10.  Human placenta sustain the growth of fetus up to 42 weeks , beyond
which it becomes too senile or dysfunctional to support the growth
 Placental dysfunction
 Risk of hypoxia and birth asphyxia

13. PHYSIOLOGICAL CHANGES
PLACENTAL CHANGES
 Ageing of the placenta , calcifications , infarctions
AMNIOTIC FLUID CHANGES
 Oligohydramnios, cloudy, presence of meconium
FETAL CHANGES
 Macrosomia ,intrauterine malnutrition

14. MORBIDITY ASSOCIATED WITH
POSTTERM PREGNANCY
 MSAF
 Meconium aspiration
 Oligohydramnios
 Non reassuring fhr in labor
 Low apgar score
 Birth injury
 Fetal macrosomeia
 Fetal weight loss
• PPHN
•Hypoglycemia
•Hypocalcemia
•Polycythemia

15.  INTRAPARTUM HYPOXIA AND STILLBIRTH
PLACENTAL DYSFUNCTION
 Reduced placental perfusion fetal hypoxia  reduced renal perfusion
oligohydromnios  cord compression variable decelerations

16.  MAS
Oligohydramnios
Meconium is undiluted and the risk of mas is high
 FETAL MACROSOMIA
Fetus may continue to grow , resulting in macrosomia
Increased risk of birth injuries
 CEREBRAL PALSY
Perinatal depression/asphyxia is associated with poor neurological outcome in long term

17. POST MATURITY SYNDROME
 Post term infants begun to loss weight , but have normal height and hc
CLIFFORD STAGING
STAGE 1
1. Dry, cracked,
peeling, loose skin
2. Malnourished
appearance
3. Decreased
subcutaneous tissue
4. Open eyed and alert,
overgrown nails
STAGE 2
1. All features of
stage 1
2. MSAF
3. Perinatal
depression
STAGE 3
1. All features of stage
1 and 2
2. Meconium staining
of cord and nails
due to long term
exposure to MSAF
3. High risk of
intrapartum and
neonatal death

18. MANAGEMENT
 ANTEPARTUM MANAGEMENT
A. Careful estimation of GA , USG data
B. Antepartum assessments
Cervical examination and monitoring of fetal well being initiated between
41 and 42 weeks on atleast weekly basis
C. Antepartum fetal surveillance

19.  INTRAPARTUM MANAGEMENT
Use of fetal monitoring
Preparation for possible perinatal depression and meconium aspiration
CTG
PARTOGRAM - prolonged 2nd stage– CS
Repetitive variable deceleration – amnioinfusion

20.  POST PARTUM MANAGEMENT
Evaluation of other conditions
congenital anomalies
perinatal depression
MAS
hypoglycemia
hypocalcemia
polycythemia

21. THANKYOU