الفهرس 
Epidemiology of Post-term PregnancyOnly 14 pages are availabe for public view
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Abstract
Postdate pregnancy is defined as the one that persists for 41 completed weeks or more.
Postdate pregnancies account for about 5 – 10 % of the deliveries and are known to be associated with increased risk for perinatal complications.
The mechanism of fetal complications associated with postdate pregnancy has attributed to progressive placental insufficiency, particularly in the presence of decreased amniotic fluid.
Management of uncomplicated prolonged pregnancies has always been a dilemma. So this study was conducted to assess the predictive values of the changes in amniotic fluid, middle cerebral artery, umbilical artery Doppler and CPR in uncomplicated postdate pregnancies.
The present study included 80 pregnant women were recruited from antenatal outpatient clinic in Ain Shams University Maternity Hospital. Pregnant women divided into two groups each according to gestational age. The study group included 40 pregnant women with gestational age more than 40 completed weeks attending the hospital for assessment of fetal well-being. The control group included 40 pregnant women with gestational age range from 37 to 40 completed weeks.
All pregnant women were submitted to ultrasound examination to detect amniotic fluid index (AFI) and color Doppler velocimetry of fetoplacental and fetal vessels including MCA-PI, UA-PI and CPR. All results were tabulated and statistically analyzed.
In the present study, there was a highly statistically significant difference between postdate and control group as regard AFI which is lower in postdate group.
In the present study, as regarding UA-PI values were (0.79+0.10) in postdated group and (0.81+0.01) in control group. These values show no statistically significant difference between both groups.
As regard Doppler indices of (MCA) the (PI) values were 1.41±0.39, 1.53±0.22 in postdated group and control group respectively. There was no statistically significant difference between both groups.
A low cerebroplacental ratio reflects redistribution of the cardiac output to the cerebral circulation and has been shown to improve accuracy in predicting adverse outcome compared with MCA or UA Doppler alone.
By dividing of MCA-PI by its equivalent UA-PI the ratio > 1.4 was consider ”normal” and < 1.4 consider ”abnormal”. Accordingly it was found that as regard the MCA-PI/UA-PI it was abnormal in 11 cases in postdated group (27.5%) and 3 cases in control group (7.5%). There was no statistically significant difference between both groups.
The sensitivity of CPR in prediction of adverse perinatal outcome was 95%, specificity 50% (PPV) 53% (NPV) 90%. The ratio was highly significant to: AFI, adverse neonatal outcome and Apgar score in both groups, while significant to: MAS and fetal acidosis in postdate group and not significant in relation to: mode of delivery and macrosomia in postdate group.
As regard AFI and according to the predictive value its sensitivity was (40%), its specificity was (80%), its PPV was (83%) and its NPV was (90%).
We found that the most sensitive test was CPR. The most specific test was AFI and MCA-PI equally by (80%) to each one. Combination of different markers improves both sensitivity and specificity.