Post-Maturity (Post-Term Pregnancy)
Definition:
A pregnancy that extends beyond 42 weeks (294 days) of gestation is called post-term or post-mature pregnancy.
Incidence:
- Occurs in 5–10% of all pregnancies.
Etiology (Causes) of Post-Maturity
- Idiopathic (Most Common).
- Placental Sulfatase Deficiency.
- Fetal Anencephaly.
- Genetic Factors (Family History of Post-Term Pregnancy).
- Maternal Obesity.
Complications of Post-Maturity
Maternal Complications:
- Prolonged labor.
- Increased risk of C-section.
- Postpartum hemorrhage (PPH).
- Infections (Chorioamnionitis, Endometritis).
Fetal Complications:
- Oligohydramnios (Decreased amniotic fluid).
- Fetal Distress (Meconium Aspiration Syndrome).
- Macrosomia (Birth weight >4 kg) → Shoulder dystocia.
- Stillbirth (IUFD) due to placental insufficiency.
Diagnosis of Post-Maturity
1. Clinical Assessment:
- Accurate dating of pregnancy using LMP & Early Ultrasound.
2. Ultrasound Findings:
- Reduced Amniotic Fluid Index (AFI <5 cm).
- Placental calcifications (Aging placenta).
- Loss of fetal fat (Post-maturity syndrome).
3. Fetal Surveillance Tests:
- Non-Stress Test (NST): Look for fetal heart rate variability.
- Biophysical Profile (BPP): Assesses fetal well-being.
- Doppler Study: Checks blood flow in umbilical artery.
Management of Post-Maturity
1. Expectant Management (41–42 weeks):
- Regular fetal surveillance (NST, BPP every 3 days).
- Monitor for decreased fetal movements.
2. Induction of Labor (After 41 weeks if no spontaneous labor):
- Cervical ripening (Prostaglandins or Foley catheter).
- Oxytocin infusion for labor induction.
3. Cesarean Section:
- If signs of fetal distress (Abnormal NST, Oligohydramnios).
Intrauterine Fetal Death (IUFD)
Definition:
IUFD refers to fetal death occurring after 20 weeks of gestation but before delivery.
Incidence:
- Occurs in 1 in 160 pregnancies.
Causes of IUFD
Maternal Causes:
- Hypertension (Preeclampsia, Eclampsia).
- Diabetes Mellitus.
- Infections (TORCH, Malaria, Syphilis).
- Rh Isoimmunization.
- Autoimmune Diseases (Antiphospholipid Syndrome).
Fetal Causes:
- Congenital anomalies (Anencephaly, Chromosomal defects).
- Multiple pregnancy (Twin-Twin Transfusion Syndrome).
- Cord Accidents (Cord Prolapse, Cord Knot).
Placental Causes:
- Placental Abruption.
- Placenta Previa.
- Fetal-Maternal Hemorrhage.
Clinical Features of IUFD
- Cessation of fetal movements.
- Absent fetal heart sounds on Doppler.
- Uterus smaller than gestational age.
- Features of fetal death on ultrasound:
- Absent cardiac activity.
- Overlapping skull bones (Spalding’s Sign).
- Gas in fetal heart or vessels (Robert’s Sign).
Management of IUFD
1. Confirmation of Diagnosis:
- Ultrasound – Absence of fetal heartbeat.
- Maternal coagulation profile (DIC risk if prolonged retention).
2. Induction of Labor for Fetal Expulsion:
- <24 Weeks: Misoprostol 200 mcg vaginally every 6 hours.
- >24 Weeks:
- Mifepristone 200 mg oral + Misoprostol 50 mcg every 4 hours.
- Oxytocin infusion if cervix is favorable.
3. Cesarean Section:
- Indicated in obstructed labor or maternal complications.
Complications of IUFD
Maternal Risks:
- Disseminated Intravascular Coagulation (DIC) if retention >4 weeks.
- Sepsis (Chorioamnionitis).
- Psychological distress & Depression.
Fetal Risks:
- Maceration (Skin peeling, Soft tissue damage).
Prevention of IUFD
- Good antenatal care with regular fetal monitoring.
- Control of maternal conditions (Diabetes, Hypertension).
- Prompt delivery in high-risk pregnancies.
Summary Table: Post-Maturity vs. IUFD
|
Feature |
Post-Maturity |
IUFD |
|
Definition |
Pregnancy >42 weeks |
Fetal death after 20 weeks |
|
Causes |
Placental aging, Genetic, Hormonal |
Hypertension, Infections, Cord accidents |
|
Diagnosis |
BPP, NST, Doppler |
Absent fetal heart, USG |
|
Complications |
Oligohydramnios, Macrosomia |
DIC, Sepsis |
|
Management |
Induction of labor |
Induction, Psychological support |
Key Takeaways
- Post-term pregnancy increases risk of fetal distress & IUFD.
- IUFD is diagnosed by absent fetal heart sounds on ultrasound.
- Early induction of labor is preferred for IUFD to prevent DIC.
Post-maturity refers to pregnancy extending beyond 42 weeks, increasing the risk of fetal distress, meconium aspiration, placental insufficiency, and intrauterine fetal death (IUFD). IUFD is fetal demise after 20 weeks of gestation, requiring urgent medical intervention.
Post-maturity and IUFD require immediate medical care. Homeopathy can be used as a supportive therapy to aid labor induction, prevent complications, and support emotional recovery.
1. Caulophyllum Thalictroides
- Weak, irregular contractions failing to initiate labor.
- Cervix remains undilated despite contractions.
- Extreme exhaustion, inability to push during labor.
- History of prolonged or difficult labors.
- Better with warmth and rest.
2. Cimicifuga Racemosa (Actaea Racemosa)
- No labor pains despite being overdue.
- Severe uterine spasms without dilation.
- Excessive fear, anxiety, and emotional distress before labor.
- History of previous difficult or prolonged labor.
- Pain radiating from the uterus to the thighs.
3. Secale Cornutum
- Dark, offensive bleeding after fetal demise.
- Uterine atony, failure of the uterus to contract properly.
- Burning pain in the uterus, better with cold applications.
- Excessive weakness, cold sweats, and trembling.
- History of previous pregnancy losses or uterine insufficiency.
4. Sabina Officinalis
- Profuse, bright red bleeding with dark clots.
- Severe pain in the lower back radiating to the thighs.
- Worsened by motion, better at rest.
- History of recurrent pregnancy loss or early postpartum hemorrhage.
- Feeling of uterine heaviness, as if everything will fall out.
5. Ignatia Amara
- Extreme grief, sighing, and inconsolable sadness after IUFD.
- Sensation of a lump in the throat, unable to cry.
- Sudden mood swings between sadness and irritability.
- Physical symptoms triggered by emotional distress (headaches, palpitations).
- History of previous pregnancy losses or traumatic childbirth experiences.
Key Takeaways
- Caulophyllum: Stimulates labor in post-term pregnancies with weak contractions.
- Cimicifuga: Helps soften the cervix and initiate labor in post-maturity cases.
- Secale Cornutum: Used for IUFD with prolonged, dark bleeding and uterine atony.
- Sabina: Aids in excessive bright red bleeding and retained placenta post-IUFD.
- Ignatia: Supports emotional recovery and grief processing after fetal loss.
Important Note:
- Post-maturity increases the risk of fetal distress and requires close medical monitoring.
- IUFD must be medically managed with labor induction or surgical evacuation.
- Homeopathy can help support labor initiation, uterine recovery, and emotional healing.
- Regular fetal monitoring, ultrasound, and medical intervention are essential in post-maturity cases.
