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Post-term Pregnancy - Surveillance Strategies
Dr. Yasir Katib
MBBS, FRCSC, Perinatologist
Depends upon the patient population
WHO (1977), FIGO (1976)
Perinatal mortality in late pregnancy according to gestational age in Sweden 1943-1952 compared with 1977-1978. Logarithm scale is used for convenience in depiction. (Adapted from Bakketeig and Bergsjø, 1991, and Lindell, 1956.)
TABLE 3 OUTCOMES IN POSTTERM PREGNANCIES (42 WEEKS OR GREATER) COMPARED WITH PREGNANCIES DELIVERED AT 40 WEEKS
(n = 8135)(n = 3457)
Factor a (%) (%)
Meconium 19 27
Oxytocin induction 3 14
Shoulder dystocia 8 18
Cesarean delivery 0.7 1.3
Macrosomia (> 4500 g) 0.8 2.8
Meconium aspiration 0.6 1.6
a For all comparisons between 40- and 42-week groups, P < 0.05.
From Eden RD, Seifert LS, Winegar A, Spellacy WN. Perinatal characteristics of uncomplicated postdate pregnancies. Obstet Gynecol. 69:296, 1987.
Postmature infant delivered at 43 weeks’ gestation. Thick, viscous meconium coated the desquamating skin. Note the long, thin appearance and wrinkling of the palms of the hands.
no evidence to demonstrate benefit as antenatal surveillance for fetal well being in post-term pregnancies
which is better???
1. Establish gestational age
2. For uncomplicated pregnancy, no evidence to support elective induction or commencement of serial antenatal monitoring at 39 to 40 6/7 weeks
3. Women who reach 41 to 42 weeks of gestation (uncomplicated pregnancies) should be offered elective delivery
4. Serial fetal surveillance should consist (as a minimum) of an ultrasound assessment of amniotic fluid volume twice weekly…other forms of monitoring may be added to this (BPP, NST and fetal movement count)