Post-Datism

Subject: Midwifery II (Theory)

Overview

Post-term pregnancy is defined as a pregnancy that lasts more than two weeks after the planned date of delivery (42 weeks or 294 days). The mother's management is determined by whether the pregnancy is easy or difficult.

The literal definition of protracted pregnancy is any pregnancy that has gone past the scheduled delivery date. However, for clinical purposes, a pregnancy that lasts more than two weeks after the projected date of delivery (42 weeks or 294 days) is referred to as post-term pregnancy. There are no standardized standards for defining extended pregnancy.

Causes

The precise cause of a protracted pregnancy is uncertain. However, several considerations must be considered:

  • Maternal Factors: Hereditary, previous extended pregnancy, primigravida, elderly, particularly sedentary habits, high socioeconomic status, and so on.
  • Polyhydramnios without anencephaly
  • Male fetus with placental sulphatase deficiency (rare).
  • Adrenal hypoplasia in the fetus
  • Extrauterine pregnancy due to low estradiol.

Diagnosis

When the mother is first seen after the predicted date, it is difficult to diagnose a post-term pregnancy. The procedure described below can be used:

  1. Last menstrual period(LMP): If the mother is certain of her date based on previous history or regular cycles It is a reasonably accurate diagnostic assistance in the calculation during lactational amenorrhea or after pill cessation. The preceding well-documented prenatal record should be reviewed in such circumstances.
  2. From the date of quickening: Normal quickening occurs between weeks 18 and 20 of pregnancy.
  3. Fundal height: Throughout pregnancy, a serial clinical record of fundal height, fetal size, and liquid volume aid in establishing gestational age and fetal size.
  4. The suspected clinical findings:
  • Weight loss
  • The girth of the abdomen: Normally, the girth of the abdomen at the level of the umbilicus increases progressively until 38 weeks and then remains constant until term. Following then, the girth gradually shrinks due to dwindling liquor.
  • History of false pain: Typically, fake pain is assumed to correspond with the anticipated date.
  • Obstetric palpation: Hand-diagnosed maturity based on uterine height, fetus size, skull bone hardness, and other factors.
  • Internal examination: A ripe cervix usually indicates fetal maturity.
  • Sonography: An early ultrasound scan can help to decrease the occurrence of genuine post-maturity.
  • X-ray abdomen: Overall fetal shadow, thickness, and density of the skull bone shadow, appearance, and density of the ossification centers in the upper tibia. (38-40 weeks) and combined to determine maturity.
  • Amniocentesis: The biochemical and cytological factors may aid in determining maturity.

Management

Before making management decisions, one should be clear about the fetus's maturity using available investigations. The mother's management is dependent on whether the pregnancy is simple or challenging.

Management of uncomplicated prolonged pregnancy

  1. A mother should admit herself inward and be allowed to contribute till the spontaneous onset of labor. Fetal well-being should be assessed on a regular basis so that early signs of fetal impairment can be addressed with induction.
  2. Exclude all potential complications, such as diabetes, CPD, toxemia, Rh-ve, and so on.
  3. Routine labor induction:
  • It is better to induce labor if spontaneous labor does not begin within 10-14 days of the EDD (a little earlier in primigravidae).
  • If the cervix is favorable (ripe), induction is performed through membrane stripping or low rupture of the membrane.
  • If the liquor is clear, an oxytocin infusion is added to make it more effective.
  • Observation is essential throughout labor.
  • If the liquid is thickly meconium stained, it indicates persistent placental insufficiency and necessitates a cesarean procedure.
  • If the cervix is not yet mature, PGE2 gel is administered vaginally. This is followed by a modest membrane rupture. When necessary, an oxytocin infusion is administered.

Management for associated complicating factor

  1. Elective cesarean section is recommended for issues such as the constricted pelvis, post-cesarean pregnancy, malpresentation, and elderly primigravidae.
  2. Complications such as pre-eclampsia, APH history, diabetes, and Rh-negative pregnancy should not allow going over the projected due date, and this is determined by elective cesarean section.

Care During Labor

  • Labor is predicted to be lengthy, whether spontaneous or induced, because of a large baby and poor head molding.
  • The possibility of shoulder dystocia should be considered.
  • Fetal monitoring should be done carefully until birth.
  • If fetal distress is detected, a cesarean section or forceps delivery should be performed as soon as possible.

 References
Things to remember
  • Post-term pregnancy is defined as a pregnancy that lasts more than two weeks after the estimated date of birth (42 weeks or 294 days). It is caused by maternal variables such as hereditary, previous protracted pregnancy, and anencephaly without polyhydramnios.
  • The mother's management is determined by whether the pregnancy is straightforward or difficult.

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