complicaciones en el embarazo: aborto,pp,dppni, embarazo ectopico
Embarazo post términofinal
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Transcript of Embarazo post términofinal
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Realizado por: E.M. PorteusE.M. Enriquez
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Post-término: embarazo de tiempo mayor a 294 días o 42 semanas completas.
Post-maduro: lactante con características clínicas reconocibles que indican un embarazo prolongado de forma patológica.
Williams Obstetricia 23a edición
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Principio del s. XX nl.
1950, probable mortalidad.
1970 se acepta un incremento en la mortalidad perinatal en estos embarazos.
Williams Obstetricia 23a edición
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ACOG definición :294 días, y 42 semanas completas.
10% de embarazos de la población mundial logran esta fecha, una pequeña proporción muestra postmadurez.
Williams Obstetricia 23a edición
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Clifford 1954:
I.- liquido amniótico claro.
II.- liq. Amn. Verde.
III.- la piel amarilla verdosa.
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Clínica: Piel descamada y arrugada
Cuerpo largo y delgado
Madurez avanzada
Arrugas en piel, manos y plantas, uñas largas
Función placentaria sin compromiso.
Sin RCI.
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Crecimiento fetal diario medio
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Williams Obstetricia 23a edición
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Fetales:
aspiración de meconio
alteraciones en el cordón umbilical
asfixia definida como apgar scores <7 (or≤6) at 5 minute
septicemia, fracturas
Daños en nervios perifericos,
Muerte neonatal y postnatal.
Efectos de disfunción cognitiva a largo plazo.
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Maternas:
Aumenta el riesgo de hemorragias posparto.
Distocia, ruptura cervical, deishecencia de Cesarea
Infección puerperal
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•Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy CHARLOTTA GRUNEWALD1, STELLAN HA ◦KANSSON2, SISSEL SALTVEDT1 & KARIN KA¨ LLE´N31Department of Clinical Science and Education, So¨ dersjukhuset, KarolinskaInstitute, Stockholm,. c 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica c 2010 Nordic Federation of Societies of Obstetrics and Gynecology 90 (2011) 26–32•Obstetric outcome in post-term pregnancies: time for reappraisal in clinical management MINNA HOVI, KAISA RAATIKAINEN, NONNA HEISKANEN & SEPPO HEINONEN Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland Acta Obstetricia et Gynecologica. 2006; 85: 805809•The Problem of posterm Pregnancy J. Obster Gynecol. Lucas WE. 1965-91 p. 241. •Post-term pregnancy as a risk factor for intrapartum fetal distress Department of Obstetrics and Gynecology, Shunji Suzuki*Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan J. Perinat. Med. 37 (2009) 420–421 • Copyright by Walter de Gruyter • Berlin • New York. DOI 10.1515/JPM.2009.055
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La mayor causa de muerte es asfixiaintraparto con aspiración de meconio.
Fisiopatología:
El feto sufre de insuficiencia placentaria porlo que aumenta su riesgo de aspirar meconioin utero.
•Obstetric outcome in post-term pregnancies: time for reappraisal in clinical managementMINNA HOVI, KAISA RAATIKAINEN, NONNA HEISKANEN & SEPPO HEINONEN Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland Acta Obstetricia etGynecologica. 2006; 85: 805809
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Manejo:
Intervención temprana en las 41 o 42 sdg, mediante inducción de trabajo de parto, cesarea o conducta expectante con monitoreofetal preparto.
Complicaciones:
Macrosomia, distocia de hombros y daño del canal de parto blando en la madre.
•Williams Obstetricia 23a edición.•Obstetric outcome in post-term pregnancies: time for reappraisal in clinicalmanagement MINNA HOVI, KAISA RAATIKAINEN, NONNA HEISKANEN & SEPPO HEINONEN Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland Acta Obstetricia et Gynecologica. 2006; 85: 805809
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•Williams Obstetricia 23a edición.
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Infante post-
término
Aspiración de
meconio
Asfixia intraparto
•Obstetric outcome in post-term pregnancies: time for reappraisal in clinical management MINNA HOVI, KAISA RAATIKAINEN, NONNA HEISKANEN & SEPPO HEINONEN Department of Gynaecologyand Obstetrics, Kuopio University Hospital, Kuopio, Finland Acta Obstetricia et Gynecologica. 2006; 85: 805809
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• Intervención en las 41 sdg.
•Menor nivel de meconio en
liquido amniótico
•Menor riesgo de asfixia
1.The Problem of posterm Pregnancy J. ObsterGynecol. Lucas WE. 1965-91 p. 241.
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Post-term pregnancy as a risk factor for intrapartum fetal distress Department of Obstetrics and Gynecology, Shunji Suzuki*Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan J. Perinat. Med. 37 (2009) 420–421 • Copyright by Walter de Gruyter • Berlin • New York. DOI 10.1515/JPM.2009.055
EG mayor a 41
sdg
Aumenta incidencia
de pH 7.1 umbilical
+
oligodramnios
Mortalidad
perinatal
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Diversos estudios apoyan la política de inducir el trabajo de parto a las 41 semanas para reducir la mortalidad perinatal.
•Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy CHARLOTTA GRUNEWALD1, STELLAN HA ◦KANSSON2, SISSEL SALTVEDT1 & KARIN KA¨ LLE´N31Department of Clinical Science and Education, So¨ dersjukhuset, Karolinska Institute, Stockholm,. c 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica c 2010 Nordic Federation of Societies of Obstetrics and Gynecology 90 (2011) 26–32•Obstetric outcome in post-term pregnancies: time for reappraisal in clinical management MINNA HOVI, KAISA RAATIKAINEN, NONNA HEISKANEN & SEPPO HEINONEN Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland Acta Obstetricia et Gynecologica. 2006; 85: 805809•The Problem of posterm Pregnancy J. Obster Gynecol. Lucas WE. 1965-91 p. 241. •Post-term pregnancy as a risk factor for intrapartum fetal distress Department of Obstetrics and Gynecology, Shunji Suzuki*Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan J. Perinat. Med. 37 (2009) 420–421 • Copyright by Walter de Gruyter • Berlin • New York. DOI 10.1515/JPM.2009.055
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Dx:
Estado fetal y valoración de condición placentaria mediante US (Clasificación de Bonilla).
Tx:
Inductoconducción de TP
Utilización de Dinoprostona y OT.
Criterios para realizar cesarea:
desproporción cefalopelvica, macrosomia, placenta senecente y oligodramnios.
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1. Williams Obstetricia 23a edición.
2. Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy CHARLOTTA GRUNEWALD1, STELLAN HA ◦KANSSON2, SISSEL SALTVEDT1 & KARIN KA¨ LLE´N31Department of Clinical Science and Education, So¨ dersjukhuset, Karolinska Institute, Stockholm,. c 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica c 2010 NordicFederation of Societies of Obstetrics and Gynecology 90 (2011) 26–32
3. Obstetric outcome in post-term pregnancies: time for reappraisal in clinicalmanagement MINNA HOVI, KAISA RAATIKAINEN, NONNA HEISKANEN & SEPPO HEINONEN Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland Acta Obstetricia et Gynecologica. 2006; 85: 805809
4. The Problem of posterm Pregnancy J. Obster Gynecol. Lucas WE. 1965-91 p. 241.
5. Post-term pregnancy as a risk factor for intrapartum fetal distress Department of Obstetrics and Gynecology, Shunji Suzuki*Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan J. Perinat. Med. 37 (2009) 420–421 • Copyright by Walter de Gruyter • Berlin • New York. DOI 10.1515/JPM.2009.055