Postmaturity

What is postmaturity?

The normal length of pregnancy is from 37 to 41 weeks. Postmaturity refers to any baby born after 42 weeks gestation or 294 days past the first day of the mother's last menstrual period. About 7 percent of all babies are born at 42 weeks or later. Other terms often used to describe these late births include post-term, postmaturity, prolonged pregnancy, and post-dates pregnancy.

What causes postmaturity?

It is not known why some pregnancies last longer than others. Postmaturity is more likely when a mother has had one or more previous post-term pregnancies. Sometimes a mother's pregnancy due date is miscalculated because she is not sure of her last menstrual period. A miscalculation may mean the baby is born earlier or later than expected.

Why is postmaturity a concern?

Postmature babies are born at the very end, or past, the normal length of pregnancy. The placenta, which supplies babies with the nutrients and oxygen from the mother's circulation, begins to age toward the end of pregnancy, and may not function as efficiently as before. Other concerns include the following:

•Amniotic fluid volume may decrease and the fetus may stop gaining weight or may even lose weight.


•Risks can increase during labor and birth for a fetus with poor oxygen supply.


•Problems may occur during birth if the baby is large.


•Postmature babies may be at risk for meconium aspiration, when a baby breathes in fluid containing the first stool.


•Hypoglycemia (low blood sugar) can also occur because the baby has too little glucose-producing stores.

What are the symptoms of postmaturity?

The following are the most common symptoms of postmaturity. However, each baby may show different symptoms of the condition. Symptoms may include:

•dry, peeling skin


•overgrown nails


•abundant scalp hair


•visible creases on palms and soles of feet


•minimal fat deposits


•green/brown/yellow coloring of skin from meconium staining (the first stool passed during pregnancy into the amniotic fluid)
Symptoms of postmaturity may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How is postmaturity diagnosed?

Postmaturity is usually diagnosed by a combination of assessments, including the following:

•your baby's physical appearance
•length of the pregnancy
•your baby's assessed gestational age

Treatment of postmaturity:

Specific treatment for postmaturity will be determined by your baby's physician based on:

•your baby's gestational age, overall health, and medical history
•extent of the condition
•your baby's tolerance for specific medications, procedures, or therapies
•expectations for the course of the condition
•your opinion or preference

In a prolonged pregnancy, testing may be done to check fetal well-being and identify problems. Tests often include ultrasound, non-stress testing (how the fetal heart rate responds to fetal activity), and estimation of the amniotic fluid volume.

The decision to induce labor for post-term pregnancy depends on many factors. During labor, the fetal heart rate may be monitored with an electronic monitor to help identify changes in the heart rate due to low oxygenation. Changes in a baby's condition may require a cesarean delivery.

Special care of the postmature baby may include:

•checking for respiratory problems related to meconium (baby's first bowel movement) aspiration.


•blood tests for hypoglycemia (low blood sugar).

Prevention of postmaturity:

Accurate pregnancy due dates can help identify babies at risk for postmaturity. Ultrasound examinations early in pregnancy help establish more accurate dating by measurements taken of the fetus. Ultrasound is also important in evaluating the placenta for signs of aging.


Spotted at Lucille Packard Children's Hospital

Down Syndrome (Trisomy 21)

Down Syndrome, or Trisomy 21, is a congenital defect (mutation) caused by the presence of an extra chromosome 21 in all cells of the individual or fetus. Babies who are born with Down Syndrome have poor mental and physical development thus motor and social skills are delayed. The syndrome usually occurs in women over the age of 35 at a ratio of 1/365. As maternal age increases up to 45, the likelihood of the mother carrying a Down Syndrome fetus is 1/32. A Triple Screen test can be used to diagnose the baby with Down Syndrome, which measures three specific levels: AFP, hCG, and estriol. The invasive procedure is done through amnioscentesis or Chorionic Villus Sampling (CVS) in which amniotic fluid is drawn up from the mother to measure the levels of AFP, hCG, and estriol. If AFP levels are depressed, but hCG and estriol are elevated, there is an increased likelihood of a Down Syndrome fetus (however in Trisomy 18, all levels are depressed).

A specific marker for determining chromosomal abnormalities such as Down Syndrome is the Nuchal Translucency (NT) measurement. This measures the thickness in the back of the fetal neck during the 11-13 week scan. If the measurement is more than 3mm, then suspect Down Syndrome. Another marker that is associated with Down Syndrome is the Nuchal Fold (NF) measurement, which is measured in the back of the "fetal head". If the measurement is more than 6mm, then suspect a Down Syndrome fetus. Below is an image showing a normal NT measurement of 1.7mm in a late First Trimester fetus.



Other ultrasonic signs that are associated with Down Syndrome include the following:

Absence of nasal bone (from profile shot)
Cleft lip and palate (from facial shot)
Ventricularmegaly or Hydrocephalus (more than 10mm/1cm)
Low ear set
Cystic Hygroma
Cushion Defect (ASD)
VSD
Moderate Band (thick papillary muscle)
Esophageal Atresia (stenosis of gastroesophageal junction)
Duodenal Atresia (double bubble sign)
Echogenic Bowel
Hydronephrosis
Clinodactyly
Short femur and Humerus length (less than 0.91)
Sandal toe
Clubfoot

Below are videos explaining about Down Syndrome and its rise (listen up techs!)...

11-13 Week Scan

Video lecture on first trimester screening that lasts for 45 minutes is a real good instructional tool for detecting pathologies. An internet course is also provided that covers all aspects of first trimester screening for chromosomal abnormalities (ie.Trisomy 21), the dignosis for major fetal defects, and screening for preeclampsia. The course, which is free of charge, is designed for techs to obtain the FMF certificate of competence which includes:

measurement of nuchal translucency
assessment of nasal bone
measurement of facial angle
assessment of ductus venous flow
assessment of tricuspid flow
measurement of uterine arter PI

After obtaining the competence, you are eligible to recieve a CME certificate.

If you want to look at the 11-13 week book, click here

For a preview of the 11-13 week scan video, click here

Video lecture spotted at fetalmedicine

Ultrasound Screening of Abdominal Aorta

really good instructional video for scanning AO to detect the presence of Aortic Anureysm...a must see for vascular techs...

Careers in Vascular Ultrasound

now that's what i'm talking about...can't wait till i study vascular...LETS GO!

The Importance of Folic Acid

really good informational video explaining about the use of folic acid that can prevent "neural tube defects", like Spina Bifida, and should be taken before pregnancy...

News Update

"Targeted breast ultrasound can reduce biopsies for women under 40"

for all you female techs out there interested on Breast Ultrasound anomalies, then you may want to read this article. I'm more of a Vascular/Echo type of guy, but the article is intersting explaining that a targeted ultrasound of suspicious areas in the breast can be a "cost-effective alternative to invasive biopsies for women under 40". Think about it..

spotted at esciencenews