Expectant mothers are often worried that childbirth does not begin earlier than the term determined by the doctors, but it also happens that the term has already come, and there are still no signs of labor. Is it dangerous and what is done if the pregnancy lasts longer than expected?
The timing at which the pregnancy is considered post-term
On average, a normal pregnancy lasts 40 weeks - during this time, the fetus develops so much that it is able to exist independently outside the mother's womb.
Most doctors call the term at which pregnancy becomes post-term, 42 weeks, but pregnancy after 40 weeks can also become this if the state of the placenta and fetus has changed.
If a woman has been carrying a fetus for 41-42 weeks, but there are no signs of an overripe child and the beginning of aging of the placenta, such a pregnancy is called prolonged.
With her, the child is born later than expected, but is healthy and full-term. One of the reasons for this "delay" of a normally developed baby inside the uterus is the woman's long menstrual cycle before conception.
True overmaturity is observed in women whose gestation period has exceeded 40 weeks, but at the same time, signs of aging began to appear in the placenta, and the condition of the fetus worsened. Such a pregnancy results in the birth of an overripe fetus.
In the following video, you can learn more about the causes of a post-term pregnancy and how to determine it.
Causes
Among the factors provoking prolongation are called:
- Violation of the menstrual cycle in a woman before pregnancy.
- Underdeveloped female genitals.
- Infectious diseases before pregnancy and during gestation.
- Endocrine diseases of the expectant mother, for example, diabetes mellitus or thyroid pathology.
- Diseases of the digestive tract and liver in a pregnant woman.
- Inflammatory diseases of the female genital organs.
- Tumors in the uterus.
- Gestosis during gestation.
- Abortion in the past.
- Reduced physical activity of a pregnant woman.
- Mental trauma or emotional distress.
- Bed rest of the expectant mother for a long period.
- Medication to prevent miscarriage.
- Mom's age is over 35 during the first pregnancy.
- The pathological course of a previous pregnancy or the birth of a large fetus.
- Great weight of the expectant mother.
- Breech presentation of the baby.
- Fetal malformations (adrenal glands, central nervous system, kidneys and other organs).
Symptoms
Prolonged pregnancy is manifested:
- A decrease in the volume of amniotic fluid. This leads to a decrease in the girth of the abdomen to 10 cm and a decrease in weight by 1 kg or more.
- Decreased skin turgor of a woman.
- The absence of flakes in the amniotic fluid.
- Sometimes the absence of a flat bubble of water, which is located above the baby's head.
- Greenish or grayish tint of waters due to the ingress of meconium.
- A denser structure of the uterus and an immature cervix.
- The beginning of excretion from the nipples is not colostrum, but milk.
- Identifying signs of baby hypoxia.
Babies born as a result of post-term pregnancy are noted:
- Wrinkled and dry skin with little or no primordial lubricant on its surface.
- Greenish tint of the skin.
- Insufficient amount of subcutaneous fat.
- Compacted cranial bones with narrow fontanelles and sutures.
- Large weight and great height.
- Long nails.
- Altered head shape.
The afterbirth will have a green color, and petrification (hardened areas) can be detected in the tissues of the placenta.
Stages
- Stage 1 - the activity of the fetus increases, and the heart rate increases. Amniotic fluid decreases slightly. Often this stage is observed at 41 weeks of gestation.
- Stage 2 - changes in the uterus begin, which are manifested by increased tone and a higher standing of the bottom. The girth of the abdomen begins to decrease every day. This stage is diagnosed at 42 and 43 weeks of gestation.
- Stage 3 - blood flow in the placenta is disturbed, resulting in hypoxic damage to the fetus. This stage occurs very rarely these days, since already at 1-2 stages of prolongation, doctors must take measures to stimulate the onset of labor.
Diagnostics
First of all, the gestational period of pregnancy is determined, counting it from the last menstruation (and if the exact dates of conception or ovulation are known, then from them), as well as on the basis of the first movements and ultrasound data.
Next, the pregnant woman is examined and the abdominal circumference, the height of the bottom of the uterus, the weight of the expectant mother are determined. A gynecological examination is certainly appointed (it will reveal an unprepared neck and changes in the fetal head) and an ultrasound scan (it will help to identify a decrease in water and the presence of inclusions in them).
After Doppler ultrasonography, the aging of the placenta is judged (by its blood flow), and cardiotocography helps to identify hypoxia in the fetus. In some cases, they also resort to cervical amnioscopic examination (if the woman's cervix is soft and slightly open). It is possible to finally confirm postmaturity only after childbirth, revealing the symptoms of fetal overmaturity.
Why is postmaturity dangerous?
A pregnancy that lasts longer than the expected period can end in complicated childbirth, sometimes with the need for surgery and an unfavorable outcome. In babies born with such a pregnancy, the risk of damage to the nervous system due to hypoxia is 2-5 times increased, because due to the dense bones of the skull and insufficient lubrication, the movement of the fetus along the birth canal is difficult.
Labor management
With a gestation period of 41 weeks, the expectant mother is hospitalized in the maternity hospital in order to resolve the issue of delivery.
Pregnancy during prolonged pregnancy can result in a spontaneous onset of labor, but quite often it is necessary to initiate labor artificially.
If the cervix is still immature, local treatment with hormonal gel or tablets is used for several days. Such drugs soften the neck and dilate the cervical canal. Next, medications are prescribed, the action of which is to stimulate uterine contractions. During childbirth, the fetal heart rate is continuously monitored.
If the crumbs develop acute hypoxia, the woman has a weak labor activity or a clinically narrow pelvis, and also in a number of other cases a post-term pregnancy ends with surgery.
Potential birth complications for mother and baby
If the pregnancy is postponed, the following situations may occur during childbirth:
- The delivery process can be delayed.
- Amniotic fluid is poured out prematurely.
- Labor activity can become discoordinated.
- Development of atonic or hypotonic bleeding is possible.
- The risk of infectious complications, such as endometritis or mastitis, increases.
- The child develops hypoxia, which threatens with hypoxic birth trauma.
- The appearance of such a serious complication as asphyxia is possible.
- Mechanical birth trauma can also occur.
- The risk of aspiration of meconium-contaminated amniotic fluid increases, which is the cause of pneumonia in the newborn.
After childbirth, the uterus may contract poorly, which threatens the accumulation of lochia and difficulties with their release from the uterus.
Consequences for a newborn baby
Babies who were born overripe may develop:
- Severe jaundice.
- Hormonal crisis.
- Skin infections.
- Neurological pathology.
- Delayed development.
Prevention
To prevent problems caused by a post-term pregnancy, the expectant mother should be more careful about her health. She can be advised:
- Planning and preparing for pregnancy.
- Visit your doctor regularly during gestation.
- Take all tests on time and carry out the prescribed examinations.
- Do not avoid moderate physical activity during pregnancy (unless there are complications). Gymnastics, breathing practices and swimming are the best choices.
- Do not refuse further examination and hospitalization if there are signs of overdue.
