Postterm pregnancy: diagnosis, timing, causes, consequences

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

It is not uncommon for a mother-to-be to give birth, the waiting period has passed, and the baby does not even think of being born. Why is that? What is the reason for this and does such a long wait pose a danger to mother and child? Let's see, when is a pregnancy considered post-term?

Delayed pregnancy - what is it?

40 weeks is the average pregnancy from conception to birth. But, this does not mean that all women in labor should wait for the baby to appear during this period. Many give birth at 36-38 weeks, and the child is absolutely he althy. There are also situations when a completely full-fledged newborn is born at 40-42 weeks. Then what kind of pregnancy is considered post-term?

Don't panic if the 41st week of pregnancy has already begun, and there are no harbingers of an early birth. Doctors evaluate not so much the terms of a post-term pregnancy as the condition of the placenta, waters and the baby itself. If everything is in order, then at the onset of 42 weeks, biological transfer is diagnosed. A toof this, from the 40th to the 42nd week, a period of "potential" postmaturity begins. "Protracted" women in labor are taken under special control, regularly monitoring the placental condition.

What are the reasons?

Postterm pregnancy is an infrequent occurrence. Of the 100% of women in labor, only 8% are at risk. And certain provocative factors lead to belated births. Why prolong pregnancy?

The main reason is hormonal imbalance, in which case the hormones responsible for labor activity are sharply reduced in quantity. Hormones in the perinatal period are very unstable, therefore they are under constant control and supervision of doctors.

Besides this, there are a number of other reasons for a post-term pregnancy:

• hereditary predisposition;
• late pregnancy, when the age of the woman in labor is over 35;
• the onset of toxicosis in recent weeks;
• inflammation in the ovaries;
• endocrine disorders;
• uterine fibroids;
• repeated previous abortions;
• infectious diseases suffered during childbearing;
• large fetal size or breech presentation;
• dysfunction of the organs of the reproductive system;
• fetal pathology (hydrocephalus, genetic diseases, adrenal dysfunction);
• frequent stress;
• Inactive lifestyle during the gestation period.

Carrying a child should be accompanied by precautions, because the body of the futuremothers are vulnerable and highly susceptible to infection and disease.

Who is at risk?

Postterm pregnancy can happen to many women in labor, but there is a category of women who are at greater risk. These include:

1. "Old-timers" women over 35 years of age. It is especially likely for those who give birth for the first time.
2. Those who have a breech presentation of the fetus in the last weeks of pregnancy.
3. Diseases of the ovaries associated with a violation of their functionality or a change in structure.
4. Having a chronic disease.

Experts strongly recommend that expectant mothers lead a he althy, active lifestyle, unless of course there is a threat of miscarriage. This will not only significantly reduce the risk of overmaturity, but also facilitate the birth process.

Signs

When the terms of a post-term pregnancy come, it is possible to diagnose this period by the accompanying symptoms. They appear both externally and internally. These include:

• weight loss of a woman in labor by 1-5 kg;
• reducing the volume of the abdomen by 5-10 cm;
• reducing the tone of the skin of the abdomen;
• frequent tone of the uterus, hypertonicity is possible when the uterus is most of the time in a compacted, even solid state;
• fetal asphyxia, when the fetus does not have enough oxygen, its movements reduce activity, heart rate decreases or, on the contrary, becomes more frequent, compaction occursskull bones;
• excretion of milk from the breast, namely milk, not clear colostrum;
• darkening of placental waters;
• aging placenta.

The listed symptoms occur after 10 days from the preliminary date of delivery. Their appearance makes it possible to put a pregnant woman at risk and radically change the tactics of tracking her pregnancy.

Diagnosis

Most often, to confirm the presence of a post-term pregnancy, they are based on timing. That is, they calculate the expected date of birth, counting the time from the last menstrual flow, determine the duration of the cycle.

But, they also examine the condition of the uterus, amniotic fluid and conduct an ultrasound examination. Diagnosis of a post-term pregnancy is necessary mainly in order to assess the condition of the fetus, because this phenomenon can affect it very, very unfavorably.

What does diagnostics include?

1. Obstetrical examination consists in measuring the volume of the abdomen, assessing the weight gain of the woman in labor, and monitoring the child's motor processes. The baby's heartbeat is heard, and the uterus is also palpated to assess its condition.
2. Examination on the gynecological chair. With its help, the stage of maturation of the placenta, the condition of the cervix, whether it is dilated, the location of the fetus, as well as the density of the bones of the fetal skull.
3. CT method (cardiotocography), which establishes the frequency of uterine contractions, and also monitors the functioning of the cardiac systembaby.
4. Doppler study. With its help, the state of blood circulation in the uterus and placenta is assessed.
5. Amniocentesis is a method that allows you to assess the condition of amniotic fluid by removing a certain amount of them from the placental sac.

As soon as the results of the examinations are unfavorable, doctors decide to immediately change the tactics of childbirth, but most often they resort to an early delivery.

Consequences of a post-term pregnancy for a woman in labor

This phenomenon is quite serious and may adversely affect the condition of the mother and the condition of the child.

For a woman, this could mean the following:

• a sharp drop in pressure;
• profuse bleeding;
• surgical intervention in the form of a caesarean section.
• long recovery period after delivery.

What threatens the child?

During a post-term pregnancy, the child suffers more than the mother. Firstly, this is the development of hypoxia, that is, a lack of oxygen. This leads to the fact that the baby can make its first breath while still in the placental sac, while swallowing amniotic fluid. Meconium (the first bowel movements of the fetus) may be present in the waters and the baby may swallow it as well. After the birth, the baby is given urgent ventilation of the lungs.

A post-term pregnancy can contribute to the fact that the child, due to active movement, wraps around the umbilical cord, pulling his neck.

Birth injury is also possible with delayed delivery. The thing is that the cranial bones of the child stop layering, thicken, making it difficult for the fetus to exit through the birth canal.

Postterm babies experience sleep disturbance after birth, are often capricious and whiny, spit up profusely after each meal, respectively, slowly gain weight and lag behind in development.

Children born later in life may develop jaundice. Oxygen starvation can trigger the release of large amounts of bilirubin into the blood. A newborn is born with a cover of skin, sclera and mucous membranes of yellow color. Jaundice can appear in any child, even in not overdue. Normally, it lasts a week and does not require any type of treatment. But in a "belated" child, such a disease can develop into a pathology and require prolonged observation by a pediatrician and treatment.

Differences in a post-term baby

A baby who is "delayed" with his birth by more than 10 days is post-term. This leads to a logical question: is such a child different from a full-term one?

Yes, such children have some features in appearance:

• too wrinkled skin, which is also thin;
• grown hair or long nails;
• dense bones, fused fontanel on the head;
• body length 56-57 cm, large head.

The appearance of a newborn baby who has been overdue may differ depending on how advanced he is. There are 3 degrees:

1. Comes at 41 weeks pregnant. The condition and behavior of such a baby is not much different from "timely" children. But, nevertheless, some changes are observed: the skin is drier, the body length is a couple of centimeters longer, the activity is slightly higher.
2. Begins at 42 weeks and lasts until 43. These children have a violation in the respiratory system. Inhalation and exhalation occurs with some difficulty, convulsions are not uncommon. Their growth is 2-3 centimeters above the norm.
3. The latest and rarest, comes from 44 weeks. To such an extent, doctors, as a rule, do not drag out the situation. But, if nevertheless this happened, then there is a high probability that the child will either be born dead, or will not live even a day. If, nevertheless, the baby survives, then his condition is assessed as critical. He quickly loses weight, eats poorly, and has difficulty breathing. These children need regular supervision for 1-2 months.

The process of childbirth. What's changing?

The consequences of a post-term pregnancy are always negative for the condition of the mother and baby. Therefore, if a woman in labor has already had this phenomenon before, then from the first days of pregnancy, she is considered to be at risk of overmaturity. And for a period of 40-41 weeks, she will be hospitalized.

Very often natural delivery is replaced by a caesarean section. It is inevitable for a woman if:

• she has a narrow pelvis;
• immature cervix;
• water has broken, and cervical dilatation does not occur for a long time;
• there is a breech presentation of the fetus;
• past birth endedthe death of a child;
• the fetus is tightly wrapped around the umbilical cord;
• overripe placenta;
• presence of postoperative scars on the uterus, which are less than 3 years old.

Caesarean is not the only delivery option. If there are no indications for it, then the process will take place naturally. But it is called artificially. Of course, a number of preparatory measures are preliminarily carried out so that the birth goes without complications.

1. Prescribe medications, the action of which is aimed at improving blood circulation in the uterus and placenta. Uterine massage is also prescribed.
2. Soften the cervix, as its timely disclosure is the key to a successful delivery. For this, prostaglandins are prescribed.
3. Prescribed taking "Mifepristone" - a drug that blocks the production of progesterone. This medication is used as emergency contraception in the first few hours after unprotected intercourse. And also it is often prescribed for medical termination of pregnancy. But, do not be afraid of its effects during pregnancy. "Mifepristone" causes contraction of the uterus, leads to the opening of the cervix, thereby provoking labor. It is prescribed if there are no contraindications to natural delivery.

Is there a prevention?

From a post-term pregnancy, the consequences for a child can be unfavorable, so every expectant mother wants to protect her baby from this fate. But to predict this phenomenonit is impossible only if the woman in labor herself already had a pre-maturity, or if one of the next of kin had it.

For such women in labor, there are a number of preventive measures that will help reduce the risk of post-term pregnancy. These include:

• monitoring the state of the endocrine system and timely treatment;
• monitoring the condition of the pelvic organs;
• responsible pregnancy planning, avoiding unwanted pregnancies through contraception, not abortion;
• birth of first child before 35;
• appeal to a gynecologist and management of pregnancy in the first trimester up to 12 weeks;
• giving up bad habits during planning and during childbearing;
• eating exceptionally he althy, balanced food, with a large presence of fruits, vegetables and protein;
• visiting a pregnancy doctor regularly, as well as taking tests and passing diagnostic methods;
• gentle exercise. These include group classes for pregnant women, which are held in fitness clubs. And also very useful are walking in the fresh air, lasting at least an hour with an average slow walk.

The presented list of actions is useful for every expectant mother, and most importantly for the unborn child.

Prolonged pregnancy

Postterm and prolonged pregnancy - the concepts are somewhat different. Prolonged is included in the concept of "normal pregnancy" anddoes not bear negative consequences for the he alth of the baby.

Both prolonged and postterm births are all varieties of late delivery, but the latter are also called overripe.

In closing

Not a single woman is insured from a post-term pregnancy, but for some it is still possible to predict the likelihood of its occurrence. You should not be afraid of it, and the main thing is to visit your gynecologist on time and not interfere with him, if necessary, change the tactics of treatment. After all, postmaturity is a huge test for the body of a newborn, which can lead to adverse consequences for his he alth.