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1. SCHOOL OF CLINICAL SCIENCES
MAKAMBO,MAKENI
 MODULE: PEADIATRICS
 TOPIC: POST MATURITY, POST TERM
PREGNANCY AND OPTHALMIC NEONATORUM
 LECTURER: DR JALLOH AMADU JALLOH
 GROUP FIVE{5}
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2. PRESENTERS
 MOMOH SESAY
 DAUDA VBS SHERIFF
 SULIAMAN S THOLLEY
 RAMATU ESTHER KAMARA
 SAMUEL PHILIP FANKA TURAY
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3. Con….
POST MATURITY,
POST TERM
PREGNANCY
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4. TABLE OF CONTENT
 DEFINATION
 EPIDEMIOLOGY
 ETIOLOGY
 DIAGNOSIS
 SIGNS & SYMPTOMS
 MANAGEMENT
 COMPLICATIONS
 PREVENTION
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5. OVERVIEW
 Post maturity/post term is a Pregnancy that extends
beyond 294 days /42 wks from first day of LMP.
 Post date or post maturity is a pregnancy continuing
beyond two weeks of the expected date of delivery.
 Post term: pregnancy >42weeks
 Post date: pregnancy exceed expected date of
delivery{40 weeks}
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6. EPIDEMIOLOGY
 Incidence 7-11%
 4%>43 wks
 Recurrence 50%
 Increased perinatal morbidity( 2-3 folds) and
mortality
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7. ETIOLOGY
 Wrong date{ inaccurate LMP}
 Biological variability{hereditary/familiar}
 Placental factors{ sulphate deficiency}
 low estrogen
 Male baby
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8. Con…..
Fetal factors{congenital anomalies like}
 Anecephaly
 Adrenal hypoplasia
 Deminshed fetal cortisol response
Maternal factors
 primiparity
 Previous prolonged pregnancy
 Sedentary habit and obesity
 Elderly multiparae
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9. DIAGNOSIS
 Menstrual history
Clinical findings:
 Weight record
 Abdominal girth
 History of false pain
 Obstetric palpation internal examination
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10. INVESTIGATIONS
ASSESSMENT OF FETAL MATURITY
 Sonography
 Amniocentesis
 Abdominal x-ray
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11. Con……
ASSESSMENT OF FETAL WELL-BEING
 Dopper
 Bio physical profile
 NST
 USG-AFI
 Clinical findings: baby general appearance, fetal
weight, lquor amnii, placenta, cord
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12. SIGNS OF POST MATURITY IN
NEWBORN
 Dry loose peeling skin
 Large amount of hair on the head
 Overgrown nails
 More alert and wide-eyed
 Green-yellowish/brownwish coloring of the skin due
to in-uteral passing of meconium
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13. FETAL COMPLICATIONS
During pregnancy:
 Fetal hypoxia due to placental insuficiency
During labour:
 Big baby{macrosomia}
 IUGR
 Cord presentation
 Fetal hypoxia and acidosis
 Meconium aspiration syndrome{MAS}
 Antepartum stillbirth
 Shoulder dystocia
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14. Con…
After delivery:
 Hypoxia and respiratory failure
 Hypoglycemia
 Polycythemia
 Increased NICU admission
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15. MATERNAL COMPLICATIONS
 Increase in labour dystocia
 Hemorrhage due to instrumental delivery
 Hemorrhage due to labour induction
 Thromboembolic disease
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16. MANAGEMENT
 Induction of labour
 Caeseran section
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17. CRITERAL FOR INDUCTION
 Bishop score > 6 likelihood of vaginal delivery is same
as spontaneous labor.
 Confirmation of gestational age by dates and early
scan to avoid iatrogenic prematurity
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18. METHODS OF INDUCTION
 Prostaglandin E2
 Mechanical methods/ laminaria tent/ foley’s catheter
 Oxytocin
 Amniotomy
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19. CONTRAINDICATIONS TO LABOUR
INDUCTION
 Placenta previa
 Vasa previa
 Transverse lie
 Breech
 Classical uterine scar
 Umbilical cord prolapse
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20. INDUCTION COMPLICATIONS
 Failed induction
 Increased CS rate
 Rupture uterus
 Hyperstimulation
 Fetal distress
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21. PREVENTION
 Women should keep truck of their menstral cycles.
 Ultrasonography in the first 12 weeks
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22. Con…..
OPHTHALMIC
NEONATORUM
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23. CONTENT
 DEFINATION
 RISK FACTORS
 ETIOLOGY
 DIAGNOSIS
 MANAGEMENT
 REFERENCES
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24. OPHTHALMIA NEONATORUM
 Is an inflammation of the conjunctival of the newborn
occurring within the first 28 days of life.
 A sticky eye is a relatively common problem in infancy.
It is often simply due to a blocked lacrimal duct but
may also be caused by a variety of bacterial and viral
pathogens
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25. Con….
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26. PREDISPOSING FACTORS
 Organisms in vagina shed during delivery
 Premature rupture of membranes
 Long delivery
 Few tears and low levels of IgA
 Trauma to epithelial barrier
 Prophylaxis (antibiotics, silver nitrate)
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27. ETIOLOGY
 Neisseria Gonorrhoeae
 Chlamydia Trachomatis
 Staphyloccus aureus
 Strep. Epidermidis
 Streptococcus pneumoniae
 E. Coli
 Pseudomonas
 Haemophilus influenzae
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28. Con……
 Herpes simplex virus.
 silver nitrate prophylaxis
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29. CHLAMYDIA:
 Is the commonest infectious cause
 4-10% pregnant women infected
 Presents at 5-14 days
 40% neonates infected
signs and symptoms
 watery conjunctivitis becoming purulent
 papillary reaction (no follicles in newborn)
 +/- pseudo membranes
 corneal scarring
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30. DIAGNOSIS
 ELISA
 Giemsa
 Culture
 direct immunofluorescent antibodies (fastest).
 PCR
TREATMENT
 Neonate- 50mg/kg erythromycin in 4 divided doses for 3
weeks,
 Ointment tetracycline 1%
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31. GONOCOCCAL
CONJUNCTIVITIS
 Beginning 24 to 48 hours after birth.
Signs and symptoms:
 hyperacute conjunctivitis associated with marked lid edema.
 Chemosis
 purulent discharge
 Conjunctival membranes may be present.
 corneal ulceration may occur and can rapidly progress to perforation.
 Septicemia and meningitis are possible
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32. DIAGNOSIS
 Gram stain (intracellular diplococci)
 culture
TREATMENT
 50,000u/kg penicillin in 2 divided doses for 7/7 or
ceftriaxone 125mg stat IM
 Topical treatment unnecessary, but eyes should be
kept clean
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33. OTHER BACTERIALS
 Usually at day 5
DIAGNOSIS
 By gram staining
 culture.
TREATMENT
 Neosporin ophthalmic covers most
 If Haemophilus:- need systemic ampicillin or
cefuroxime as well
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34. VIRAL TREATMENT
 IV Aciclovir: Neonatal Herpes Simplex Virus
Infection)
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35. REFERENCES
 . Conjunctivitis - infective; NICE CKS, August 2012 (UK accessonly)
 2. Chlamydia; Public Health England
 3. Chlamydial Infections, Sexually Transmitted Disease Treatment
Guidelines 2010; CDC Centers for Disease Control and Prevention
 4. The Wills Eye Manual
 5. Recommendations for the prevention of neonatal ophthalmia;
Canadian Paediatric Society
 6. Denniston AKO, Murray PI; Oxford Handbook of Ophthalmology,
Oxford University Press, 2009
 7. List of Notifiable Diseases; Public Health England under the Health
Protection Act Regulations April 2010
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