Pediatric aspects of the placental dysfunction syndrome in postmaturity.

Abstract

Prolonged gestation with a normal placenta presents no pediatric problem unless delivery is abnormal or prolonged. Prolonged gestation in the presence of placental abnormality is likely to result in either fetal death in utero or severe postnatal symptoms of anoxic injury to the respiratory and nervous systems. Mild (stage 1) placental dysfunction is marked by the finding of loss of vernix, desquamation, white skin, long nails, abundant hair, alert facies, loss of subcutaneous tissue, and an appearance of malnutrition; in the author's experience there has been no mortality in this group, but one case of severe injury to the nervous system. More severe placental dysfunction (stage 2) is marked by the finding of meconium in the amniotic fluid, with staining of the contiguous structures and signs of fetal hypoxia. Permanent damage to the central nervous system was frequent in this group; one-third died, and only one-third had a normal clinical course. The most severe degrees (stage 3) of placental dysfunction are marked by a change of pigmentation from green to yellow and maceration of the skin; intrauterine mortality is high because of severe damage to nervous and respiratory systems. As many as 5% of all pregnancies end on or after day 301. Fortunately, the vast majority of prolonged pregnancies have adequately functioning placentas.