INTRODUCTION

Postdated pregnancy is an everyday problem for the obstetrician. In this study the various aspects of postdated pregnancy and risk to the fetus in postdated pregnancy were evaluated, such as to find out the socio epidemiological factors in postdated pregnancy , to study the obstetric consequences of postdated pregnancy and to study the impact of postdated pregnancies in perinatal morbidity and mortality.

MATERIALS AND METHODS

          The study was carried out in 100 patients from GTMCH, Theni, during the period from Jan 2017 to Dec 2018. Besides detailed history, all patients after admission underwent obstetrical examination (special reference to amount of liquor and feel of the head) and routine antenatal investigation.  The patients were also taught to keep a fetal kick chart.

          Primary surveillance was done with Real–time Ultrasound fetal evaluation. Each of the variables was coded as normal or abnormal.  These ultrasonic parameters were used as a criteria in deciding the time and mode of delivery.  Early amniotomy to detect meconium and careful fetal monitoring during labour was undertaken

RESULTS

Among the study group 68% of women were between 21–30 years. 44 women were primigravida. Among those 44 primigravida  2 were elderly primi. 12% of the cases gave history of consanguineous marriage and no congenital anomaly was found among any one of them or in the present study group. Incidence of post term pregnancy is varied from 4.4% to 14.9%.

Foetal distress and meconium release occurred more commonly in postdated pregnancy. There was a progressive decrease in the amniotic fluid volume after 40 weeks. There were 49 cases (49%) went into labour with normal biphysical scoring.  3 of them (6.12%) showed evidence of foetal distress in labour.  2 of the babies had a apgar score of less than 7 (4.08%).

Among the 82 cases where the labour was induced 92% delivered vaginally and only  8% delivered by caesarean section.  There was a slight increase in the incidence of instrumental deliveries (13.3%).  50% of the cases the indication for instrumental delivery was foetal distress.

 The present study neonatal asphyxia was found in 6% of the cases.  The number of pregnancies complicated by evidence of foetal distress was 13 and among them 4 babies had meconium aspiration

CONCLUSION

          Post mature pregnancy is a complex perinatal problem and ranks as a major source of perinatal morbidity and mortality, among term pregnancies.  To improve the outcome attempts should be made to determine the estimated date of confinement in all pregnancies before the third trimester by emphasizing the early and regular antenatal checkup.  Antepartum surveillance should be performed in all pregnancies that might have reached 42 weeks of amenorrhoea.

          Emergence of improved antepartum testing and effective cervical ripening agents (Prostaglandins and relaxin) may improve the outcome and management of postdated pregnancies.

          During the intrapartum period special attention should be paid to careful fetal monitoring.  Anticipation for the complication and proper management of the baby in the neonatal unit goes a long way to improve the outcome in post dated pregnancy.