Postterm Infant

Over 42 weeks of gestation.

• 1. General aspects
  1. Labor may be hazardous for mother and fetus because:
  1. Large size of infant contributes to cephalopelvic disproportion; obtain estimate of fetal weight (EFW) by ultrasound.
  2. Placental insufficiency-fetal hypoxia; diagnosis by:
  1. Contraction stress test.
  2. Nonstress test
  3. Amniotic fluid index (AFI).
  3. Meconium passage (common physiological response) increases chance of meconium aspiration.
  2. Assessment:
  1. If postmature skin: dry, wrinkled-due to metabolism of fat and glycogen reserves to meet in utero energy needs.
  2. Long limbs, fingernails, and toenails-due to continued growth in utero.
  3. Lanugo and vernix-absent.
  4. Expression: wide-eyed, alert-probably due to chronic hypoxia (oxygen hunger).
  5. Placenta-signs of aging.
  3. Analysis/nursing diagnosis: High risk for injury related to high incidence of morbidity and mortality due to dystocia or hypoxia.
  4. Nursing care plan/implementation:
  1. During labor:
  1. Goal: emotional support of mother-may require cesarean birth due to CPD or fetal distress.
  2. Goal: continuous electronic monitoring of FHR. Report late decelerations immediately (indicate fetal distress).
  2. Afterbirth:
  1. Goal: if born vaginally, prompt identification of birth injuries, respiratory distress. Continual observation.
  2. goal: early identification/treatment of emerging signs of complications.
  1. Hypoglycemia-Dextrostix readings and behavior.
  2. Administer oral or intravenous glucose, as ordered.
  5. Evaluation/outcome criterion: successful transition to extrauterine life (all assessment findings within normal limits).