过期妊娠产科病区ppt课件.pptVIP

Prolonged Pregnancy;Posterm pregnancy is defined as a pregnancy that extends to 42 0/7 and beyond incidence: 3-12% however the actual biologic variation is likely less since the most frequent cause of a postterm pregnancy diagnosis is inaccurate dating;Fetal Neonatal risks: Perinatal mortality rate at 42 wks is twice that at 40 wks increases to 4 folds @ 43 wks and to 5-7 folds at 44 wks;20% of postterm fetuses have post maturity syndrome,which is characterised with chronic intrauterine growth restriction from uteroplacental insufficiency.These pregnancies are at increased risk of umbilical cord compression from oligohydramnios,non-reassuring CTG,intrauterine passage of mec,hypoglycemia,seizures,and respiratory insufficiency;Macrosomia and bith injury fetal acidemia Neonatal death Cerebral palsy;Maternal Risks increase in labour dystocia (9-12% vs 2-7% at term) Increase in severe perineal injury (3rd and 4th degree tears) related to macrosomia (3.3% vs 2.6% @term) and operative vaginal delivery,and a doubling in the rate of Caesarean delivery (14% vs 7% at term) which is associated with higher risks of endometritis,haemorrhage,and thromboembolic disease; The emotional impact (anxiety and frustration) of carrying a pregnancy 1-2 weeks beyond the estimated du date should not be underestimated; 20% of pregnant women will require IOL,the majority for prolonged pregnancy 58% of women will have delivered by 40 wks of gestation,74% by 41 wks of gestation and 82% by 42 wks of gestation;Ensure that the pregnancy has been dated correctly Dating U/S in the first trimester reduces rates of IOL for post-term pregnancy NICE advise U/S scans to determine gestational age using: CRL measurement from 10 wks 0 days to 13 wks 6 days Head circumference if CRL is above 84 mm U/S dating should not be postponed further than 24 completed wks irrespective of how sure women are of their menstrual dates;When to Induce Women with uncomplicared pregnancies should be given every opportunity t