妇产科学课件：Postterm pregnancy

1、Postterm pregnancy Definition Prolonged pregnancy, post-dated pregnancyPregnancy that has reached 42 weeks(294 days) of completed gestation from the first day of the last menstruation or 40 weeks gestation from the time of conceptionMenstrual cycle is normal 2830 daysThe frequency of postpartum preg

2、nancy is 510%Etiology Unclearly, maybe correlate to fetal adrenal cortex Surmise the mechanism for the initiation of parturition has some abnormalitiesPG and E deficient, P increasePlacental sulfatase deficiencysex-linked recessive inheritance, in male, E Fetal malformationAnencephalic fetus, hypopl

3、asia of adrenalsPhysiologyPlacental function is sufficient Fetus growth, macrosomia, shoulder dystociaSkull calcifiedPlacental function is insufficientThree stagePostmaturity syndrome(PMS): infants are withered, meconium-stained, fragile, with long nails and peeling skinPlacenta: thinner, infarcts,

4、fibrin deposition and calcificationComplication Perinatal morbidity rates increased sharplyFetal distressmeconium aspiration syndrome(MAS), asphyxiaTrauma: shoulder dystociaMental retardation and neurologic sequelaeMother: manipulative delivery is increasedDiagnosis and Treatment Dating the pregnanc

5、y againDate the LMPPositive Serum HCG at 5 weeks, urine HCGFetal heart tones auscultated with a stethoscope at 1820 weeks, with electronic device in 10 weeksPhysical exam of uterus: height of fundus, bimanual Maternal perception of quickeningUltrasound: crown-rump length, diameter of BPD2. Evaluatio

6、n of the fetus Normal fetal movement 10beats/12h Electronic fetal monitoring: NST, CST, 23 times weeklyUltrasound evaluation ( biophysical profile) , 4 abnormalUltrasound measurement of the amount of amnionic fluid: AFI( amnionic fluid index)8 in normal, 4000g or FGROther severe complication: eclamp

7、siaoligohydramnionsDiagnosis and Treatment Vaginal deliveryCervical ripen: artificial rupture of fetal membrane Cervical unfavorable: use medicine to make it ripenCesarean sectionCervix is unfavorableInducing labor is failedFetal distressDystocia: fetopelvic disproportion Diagnosis and Treatment Sum

8、maryGestation 42 weeksFetal movementAmnionic fluidBiophysical profile6CST positiveNST nonreactiveCSInduced Vaginal deliveryAFI5See you next time!BPD diameterThorax diameterAbdomen diameterfemurAmnionic fluid Placenta Early stageDry parchment like skin, wrinkling and peelingLong finger nailsThin, long infantIntermediate stageMeconium stained membrane, placenta and fetal skinAdvanced