Post-term pregnancy is an extension of the pregnancy period by more than 10-14 days from the due date of birth. In other words, a post-term pregnancy should be considered a pregnancy that lasts more than 42 weeks.
Normally, pregnancy lasts 38-41 weeks, counting from the first day of menstruation. Most women give birth at 40 weeks. Post-term pregnancy occurs in approximately 10% of the total number of pregnancies and is not always a pathology.
In what cases is post-term pregnancy a normal option, and in what cases is it a pathology?
The fact is that there are two types of post-term pregnancy: true (or biological) and false (or prolonged pregnancy).
With true postmaturity, the fetus continues to develop and reaches a higher degree of maturity than expected for intrauterine development. As a result, the child is born with signs of “overmaturity.” Why is this dangerous? It is a well-known fact that such essential functions How breathing, nutrition and excretion of fetal metabolic products is carried out by an organ called the placenta. During the 9 months of pregnancy, the placenta forms, grows, matures and ages. When the placenta begins to age, which happens during postmaturity, it decreases in size and regresses. Such a placenta can no longer adequately provide for the needs of the fetus. As a result, metabolism deteriorates, which leads to fetal hypoxia (lack of oxygen), which can lead to its death. Therefore, true post-term pregnancy is a pathology and requires medical intervention.
With false post-maturity, the opposite picture is observed. Despite the fact that the pregnancy period is lengthened, the child develops absolutely normally and is born without signs of “overmaturity.” The placenta does not regress or age. Consequently, false post-maturity is the norm and it is caused, first of all, by individual characteristics the fetus, that is, its slow development.
The main reasons for post-term pregnancy include: endocrine diseases in the mother, in particular diabetes; obesity, age over 35 years, past abortions, inflammatory diseases of the genital area, irregular menstruation, psycho-emotional shocks, heredity (if there have been cases of post-term pregnancy in your family), sedentary lifestyle during pregnancy.
Let's figure out in what cases you can calmly wait for the upcoming birth, and in what cases you need the help of an obstetrician-gynecologist.
Let me say right away that no matter how you feel, if the 41st week of pregnancy has already approached, and there are no precursors of labor (cramping pain in the lower abdomen, passage of the mucus plug, rupture of amniotic fluid), then you should contact an obstetrician-gynecologist, who will recommend that you be admitted to a maternity hospital. Next, doctors will try to find out whether this post-term pregnancy is true, or whether it is just a prolonged pregnancy.
In addition, if you are postterm, you should be alerted to such symptoms as a decrease in abdominal circumference by 5-10 cm by the end of pregnancy, lack of weight gain, decreased activity of the fetus (decreased fetal movements), and dry skin. Enough dangerous symptom post-maturity is the discharge of greenish-colored water. This may be a sign of fetal hypoxia. Therefore, if you have the above symptoms, you should immediately contact your obstetrician-gynecologist.
Examination during postterm pregnancy
Upon admission to the maternity hospital, the pregnant woman is examined: the gestational age is re-calculated various methods(by the date of the last menstruation, by conception, by the first movement of the fetus, according to ultrasound data) to make sure that there really is a post-maturity, since some mothers sometimes simply rush the birth of the child.
A gynecological examination is carried out to determine the degree of maturity of the cervix, that is, its readiness for the upcoming birth. Measuring the size of a pregnant woman's pelvis
To assess the condition of the fetus and placenta, ultrasound and Doppler studies of the speed of blood flow from the placenta to the fetus are performed.
The purpose of these studies is to determine how mature the placenta is for a given gestational age, whether it contains “petrificates” (hardened areas that are unable to perform its function) and how well the blood supply to the placenta and fetus occurs. The amount of amniotic fluid is also assessed (if post-term pregnancy occurs, oligohydramnios occurs) and the estimated weight of the fetus.
To assess whether the fetus is suffering from pathological changes in the placenta, CTG (fetal cardiotocography) is performed.
Depending on the examination data, the management tactics for the pregnant woman are determined.
Childbirth during postterm pregnancy
If the cervix is mature (there is shortening and a slight opening), then during postmaturity, surgical induction of labor is indicated - amniotomy (the amniotic sac is pierced).
If, according to a gynecological examination, the cervix is immature (there is no prenatal shortening and opening), and according to ultrasound data there is a tendency towards post-maturity, then to accelerate the ripening of the cervix, drugs that stimulate labor are used (Prepidil gel, kelp sticks).
If within 4 hours after amniotomy labor has not intensified, the synthetic hormone Oxytocin is administered intravenously to intensify contractions (if there are no contraindications, such as a narrow pelvis, discrepancy between the size of the pelvis and the expected size of the fetal head, incorrect position of the fetus). Also, to enhance the contractile activity of the uterus, glucose solution, vitamins C and B1 are used intravenously. If the actions taken do not cause the desired effect (and this is possible!), then a caesarean section is indicated.
The situation during childbirth with post-term pregnancy is further aggravated by the fact that the “post-term” fetus is usually large, which significantly complicates its passage through the mother’s birth canal. Often, due to prolonged labor with a large fetus, a woman in labor develops weakness in labor. At the same time, the doctor is always interested in faster delivery in case of postmaturity, since the fetus is in conditions of chronic hypoxia, which can be expressed in the form of an outpouring of green amniotic fluid. Therefore, you should know that the very fact of post-term pregnancy is a relative indication for cesarean section.
If at the prenatal stage, according to ultrasound, Doppler and CTG, signs of fetal hypoxia and placental insufficiency are revealed, then cesarean section is the most acceptable method of delivery, allowing to insure the child and mother from possible severe complications during childbirth.
Possible complications during post-term pregnancy:
fetal hypoxia, antenatal or neonatal fetal death (before or after birth); birth injuries of mother and fetus, fetal macrosomia (weight more than 4000-4500 g).
How to induce labor yourself
Avoiding post-term pregnancy is not so difficult. To do this, you need to maintain a healthy and active lifestyle throughout your pregnancy. This is especially true for pregnant women with risk factors for post-term pregnancy (late births, endocrine disorders etc.).
Try to do special breathing exercises throughout pregnancy. This means walking on fresh air at least 30-40 minutes a day, swimming, yoga and aerobics for pregnant women.
If there are no contraindications, then sexual activity is recommended in the last weeks of pregnancy (at 39-40 weeks). The fact is that sperm contains prostaglandins, which help soften the cervix and open it, which has a very beneficial effect on the course of labor. Again, this is a double-edged sword. During active sexual intercourse, there is a possibility of placental abruption (and this is a threat to the life of the fetus) or infection (even opportunistic microorganisms such as ureaplasma or E. coli can cause complications during pregnancy).
The psychological mood of a pregnant woman is also important. Due to constant fear, anxiety and stress before the upcoming birth, the process of labor may be delayed. It must be remembered that depending on your mood, the child receives either “joy hormones” or “stress hormones”. To start the birth process, you need to tune in to positive emotions and then your baby won’t keep you waiting long!
Consultation with an obstetrician-gynecologist on the topic of post-term pregnancy
Question: At what date should I contact a gynecologist if labor does not begin on its own?
Answer: At 40-41 weeks of pregnancy.
Question: Can sex trigger labor?
Answer: Yes.
Question: I am 41 weeks pregnant. Ultrasound diagnoses placental insufficiency. Is it possible to give birth on your own?
Answer: It is possible if there are no signs of fetal hypoxia.
Question: Is it true that a child after a post-term pregnancy can be born mentally retarded?
Answer: Not true. In 20-30% of cases, it was actually noticed that children after a delayed birth later begin to sit, walk, talk, etc. However, everything is very individual and largely depends on the attention and care of parents.
Question: Could too much weight gain towards the end of pregnancy indicate post-term pregnancy?
Answer: No.
Question: Is aging of the placenta according to ultrasound data a sign of post-maturity?
Answer: Not always; aging of the placenta can occur at 30 weeks of pregnancy. But with postmaturity (if it is not false), aging of the placenta occurs in almost all cases.
Question: How quickly is a caesarean section performed in case of postmaturity, if there is an indication?
Answer: Caesarean section is performed routinely after hospitalization up to 42 weeks.
Obstetrician-gynecologist, Ph.D. Christina Frambos
Women quite often experience a feeling of worry when labor does not begin on time. Doctors say that post-term pregnancy can affect the unborn child, which frightens the pregnant woman even more. Previously, the diagnosis of post-term pregnancy was often made due to the fact that the expected due date was determined incorrectly, because in order to determine whether the pregnancy is really post-term, you need to know exactly the day of conception.
Since many women do not know exactly when they became pregnant, it is customary to count 40 weeks from the first day of the last menstrual period. It is worth noting that deviations of 2 weeks are allowed, that is, labor can begin at 38 or 42 weeks. If the pregnancy lasts more than 42 weeks and a child is born without signs of overmaturity, then such a pregnancy is called prolonged.
If a woman’s menstrual cycle lasts more than 28 days, then a pregnancy that lasts more than forty weeks is considered normal. The longer the menstrual cycle, the longer a woman can go without any fear. It is also worth noting that women whose cycle is less than 28 days can give birth starting at 36 weeks.
Also, the likelihood of post-term pregnancy increases if there were any complications in the first trimester of pregnancy. In addition, it is worth considering heredity. So, if someone in a woman’s family carried a pregnancy to term, then this can be expected from her as well.
The psychological factor also plays an important role. Quite often, a woman gives herself a certain goal - to give birth by a certain date, and often the body adapts to the appointed date.
Post-term pregnancy and its consequences
This question worries many women whose labor is in no hurry to begin on time. A truly post-term pregnancy can cause complications not only in the fetus, but also in the mother. Postmaturity increases the risk of morbidity and mortality in newborns.
Babies who are postterm often experience a lack of oxygen, if the placenta can no longer provide the child with the necessary amount of it, this can lead to. In addition, the risk of birth trauma and retention of amniotic fluid in the baby’s lungs increases.
It is worth noting that post-term pregnancy can also affect the health of the mother. First of all, the risk of needing a caesarean section increases. Often, during the natural birth of a large fetus, injuries to the birth canal occur, which in the future can lead to unpleasant consequences and the need to treat complications.
Considering the possible complications, post-term pregnancy should be treated very carefully and strictly follow the recommendations of the gynecologist leading the pregnancy.
Postmaturity and overripeness - what is it?
Typically, a pregnancy that lasts more than 42 weeks is called post-term. Children born later than expected often show signs of overmaturity. However, these two concepts should not be confused and combined.
Both late birth without signs of overripeness of the fetus and delivery at the appointed time with a fetus with signs of overripeness are possible. In other words, “postmaturity” is a temporary concept, and “overmaturity” indicates the condition of the newborn.
Post-term pregnancy beyond 42 weeks is not very common, only in 1-3% of cases. In most situations, doctors try to permit childbirth after the 40th week of pregnancy, this is explained by the fact that specialists are trying to reduce the risk of complications.
The degree of post-term pregnancy after 40 weeks of pregnancy is determined on the basis of medical research.
What are the signs of post-term pregnancy?
If the pregnancy is truly post-term, then childbirth should be allowed as quickly as possible. Why is labor slow to begin? What prevents labor from occurring and indicates that the pregnancy is post-term?
First of all, one of the signs of postmaturity is sudden reduction in amniotic fluid volume . This sign is also a harbinger that labor will be weak.
It happens that pregnant women no flat bubble , which fits the baby's head. It can also delay the onset of labor and affect cervical dilatation.
If at 40 weeks of pregnancy the uterus is immature, this may indicate a potential post-term pregnancy.
When conducting an ultrasound examination, a specialist may find that there are no flakes of cheese-like lubricant in the amniotic fluid – this indicates overripeness of the fetus and indicates dry skin of the child.
If the doctor sees on an ultrasound signs of placenta aging , then this indicates that the placenta is not able to cope with the needs of the growing body. Troubled waters indicate that the child is experiencing oxygen starvation, this is one of the signs of post-term pregnancy, if detected, it is worth allowing birth as quickly as possible.
Symptoms that help determine post-term pregnancy include: dehydration (reduction of the abdomen in volume), weight loss of the pregnant woman, secretion of milk from the breast instead of colostrum.
What are the reasons for post-term pregnancy?
Medical professionals suggest that the basis for post-term pregnancy is lack of “biological readiness” female body for childbirth. This may be caused by dysfunction of the central nervous system the expectant mother and fetus, as well as the functions of the placenta.
Post-term pregnancy can be caused by immature fetal immune system , as well as a lack of certain vitamins. Diseases endocrine system in the mother, previous abortions, diseases of the reproductive system, mental trauma and breakdowns may underlie post-maturity. Heredity also plays an important role. Previous pregnancies among relatives increase the likelihood of post-term pregnancy.
In addition to the medical aspect of post-term pregnancy, which is described above, there is also psychological aspect . Labor may not begin due to various fears and phobias of the pregnant woman.
So, often, when there is a threat of termination of pregnancy, the expectant mother begins to behave in such a way as to minimize the possibility of miscarriage or premature birth.
Of course, this is good during pregnancy, but often this behavior of a woman can interfere with the onset of labor.
Normal prenatal processes often cause fear in a pregnant woman. In order to stimulate labor in such a case, it is necessary to reduce the psychological stress, increase the number of walks, do gymnastics and swimming.
Unconscious fears can also cause post-term pregnancy. You can cope with these fears in childbirth preparation courses or in personal consultation with a psychologist.
If during pregnancy you were quite active, and before giving birth you calmed down and relaxed, and began to enjoy your condition, then this can also lead to a delayed birth.
Thus, we can conclude that psychological condition a woman and her readiness for childbirth largely influences whether the pregnancy will be post-term.
A test to determine a woman's readiness for childbirth
In order to carry out this test, you need to take a comfortable position and place a watch next to it. It is necessary to irritate the areolas and nipples with your fingers for a minute after three minutes. In order to track contractions, you should place your hand on your stomach.
The test result is considered positive if the uterus begins to contract within the first three minutes after the start of exposure to the nipples, and at least three contractions occur within 10 minutes.
If at 40 weeks the test gives a negative result, then the likelihood of postmaturity increases. If the test is positive, but labor does not begin, it means that the baby is not yet ready to be born.
Prevention of post-term pregnancy
For women who are at risk, first of all, it is necessary to calculate the expected date of birth as accurately as possible. Even if the pregnancy proceeded without complications, the woman is sent to the hospital after 40 weeks of pregnancy to undergo a complete examination of the fetus and determine the degree of maturity of the cervix.
If the diagnosis of “post-term pregnancy” is confirmed, the doctor must decide on the course of delivery. How the birth will proceed depends on the woman’s readiness for the birth process, the condition of the placenta, the pregnant woman’s history of illnesses and other important factors. If there are aggravating factors, the method of delivery chosen is cesarean section.
If the condition of the pregnant woman and the fetus is satisfactory, then they resort to stimulating the birth process with the help of medications. In this case, the birth of the baby occurs naturally.
In the end, I would like to note that about 96% of children born late are born absolutely healthy, but in any case, you should not let the situation take its course; post-term pregnancy should be treated very carefully and the condition of the fetus should be constantly monitored.
I like!
The meaning of the concept of premature pregnancy is known to almost everyone adult woman- This is the birth of a child before the due date. In obstetric practice, this limit is the 37th week - if birth occurs before it, then it is considered premature. But few people know about the upper limit of the norm, although when it is reached, the risk of developing another pathological condition– post-term pregnancy.
The appearance of signs of this pathology is caused by oxygen starvation of the fetus - if the birth does not occur on time, the placenta still begins to gradually lose its functions. This occurs due to a clear genetic program inherent in the body of every woman, which ensures fluctuations in hormone levels. If some kind of malfunction occurs in it, then the birth of the child does not occur on time. And inside the uterus, degenerative changes are already beginning, associated with the “over-ripening” of the fetus and its membranes.
The most important mechanism is the aging of the placenta, which immediately worsens the blood supply to the baby. It is the lack of oxygen and nutrients explains the severity of the consequences that develop when the management of a woman with such a pathology is carried out incorrectly. IN Lately There is a steady increase in such conditions, which determines their relevance and the need for detailed study.
Causes
First of all, you should consider general processes leading to the development of post-term pregnancy. The peculiarity of this pathology is the absence of specific reasons for its development. There are only certain risk factors that, when combined, can suppress the generic dominant that arises when the child matures in a timely manner.
If this moment is missed by the body, then amniotic fluid does not rupture and uterine contractions do not begin. Pregnancy seems to continue, but with pathological features:
- Due to a gradual decrease in progesterone, placental dystrophy develops - foci of desolation, hemorrhage and compaction appear in it. The speed of blood flow through its vessels decreases, which negatively affects the child’s condition.
- The baby's brain matures more and more during post-term, which makes it more sensitive to the lack of oxygen caused by placental insufficiency.
- The maturation of the nervous system determines the appearance of the first reflexes - although the child has not yet been born, he is trying to breathe. This leads to the entry into the lungs of amniotic fluid, contaminated due to a decrease in metabolic processes through the placenta.
- A long delay in childbirth creates conditions for compaction of the skull bones and a reduction in the size of sutures and fontanelles. Combined with a mature brain, these factors often make vaginal birth impossible.
Despite the variety of risk factors, post-term pregnancy always proceeds according to the listed algorithm - depending on the cause, the speed of its development can only change.
Are common
This group includes only those conditions that, to a certain extent, can affect the level of sex hormones. It is the violation of clarity and coherence in their work that leads to the lack of coordinated labor activity that occurs exactly on time. The most commonly observed risk factors for the development of such conditions are:
- Pregnancy occurs after the age of 30, which is explained by the gradual aging of the reproductive system. This criterion applies not only to postmaturity, but also generally increases the possibility of a complicated course.
- Any endocrine diseases accompanied by a pronounced effect on hormone metabolism. These include diabetes mellitus, obesity, pathology of the thyroid gland (especially hypothyroidism) or adrenal glands.
- Functional lesions of the nervous system, leading to a predominance of the tone of the parasympathetic nerves. Their development is usually associated with the lack of a protective regime for the pregnant woman, which contributes to the development of stress.
- An imbalance of sex hormones, usually manifested by menstrual irregularities, which was not compensated before conception. If pregnancy does occur, then its course against such a background is rarely stable.
For some reason, the common reasons for post-term pregnancy are often underestimated when preparing for it, which ultimately results in the development of complications in the mother or child.
Local
Also, during observation, local factors were identified that led to the immaturity of the entire reproductive system at the time of birth. As a result, a discrepancy arises - the fetus grows and develops according to the deadlines, but the structures surrounding it are delayed. The following local processes contribute to this situation:
- The main factor is considered to be a deviation in the normal formation of the placenta, which leads to its functional inferiority. At the same time, it does not so much disrupt metabolic processes in the fetus as contribute to the development of hormone deficiency.
- If local hormonal regulation is disrupted, then the uterine wall is unprepared for the onset of labor. It does not accumulate a sufficient volume of muscle fibers, as well as the number of receptors necessary for its effective and timely contractions.
- The lack of blood supply to the fetus primarily affects its nervous and endocrine systems, which affects the release of special stimulant substances. Their deficiency determines that the mother’s body misses the moment of the onset of labor.
Local factors are closely related to general causes, since their occurrence is impossible without disruption of a woman’s hormonal levels due to some disease.
Criteria
It makes no sense to focus only on the period (more than 42 weeks), although in post-term pregnancy it is one of the indicators. In establishing a diagnosis, it is the combination of the time indicator and objective symptoms of fetal overripeness that is important. They can be divided into two main groups:
- Initially, signs are identified before the onset of labor in order to determine further management tactics. They are assessed after 40 weeks, if there are no precursors of labor - these include an objective increase in the height of the uterus and a decrease in abdominal circumference. Instrumentally, using CTG, signs of hypoxia in the child are determined, and ultrasound determines placental dystrophy.
- After birth, a post-term pregnancy can be confirmed by appearance child (skin, hair and nails), as well as characteristic changes amniotic fluid, umbilical cord and placenta.
There is a related concept of prolonged pregnancy - if the gestation period exceeds 42 weeks, but there are no signs of fetal overripeness.
Lead tactics
Since all women who are approaching the time of labor are sent to the maternity hospital, doctors rarely have problems diagnosing this pathology. From 40 to 42 weeks, expectant management is used, during which optimal method delivery. Considering the condition of the mother and child, the following options are possible:
- If signs of placental dystrophy and fetal suffering have been identified before 40 weeks, then the mother begins preparing for a planned cesarean section. They try to perform it as quickly as possible in order to avoid the development of serious complications in the baby.
- If the general condition of the child has not changed, but there are temporary criteria for post-term pregnancy, then childbirth is resolved naturally. To do this, artificial medicinal preparation is carried out to ensure the opening of the cervix and the appearance of contractions.
- The third option is an emergency caesarean section - it is carried out only if labor stimulation has failed. Oxygen starvation of the fetus, combined with the weakness of its expulsion, becomes an immediate indication for surgery.
Post-term pregnancy is an irreversible process, which is why the only way to treat it is to immediately carry out an “artificial” birth.
Consequences
The risk of immediate and long-term complications directly depends on how long the child was in conditions of lack of oxygen. As long as the blood supply through the placenta meets the needs of his body, there is no need to fear for his future health. It is fetal hypoxia that becomes the triggering factor for other pathological mechanisms that start in the baby’s organs and tissues.
First of all, the tissue most sensitive to oxygen levels, the nervous tissue, suffers, which causes high frequency complications specifically from the brain. Consequences associated with direct damage are also often observed respiratory system And skin. But almost all long-term complications are caused by irreversible damage to the brain due to insufficient blood supply and damage during childbirth.
Early
Most of the conditions listed in this paragraph are fatal to the newborn. If the disorders cannot be corrected with medication, the child dies a few days or weeks after birth. The most commonly observed lesions are:
- The most common condition is acute respiratory distress syndrome (ARDS of newborns), associated with the destruction of a special substance in the lungs - surfactant. Normally, it prevents the adhesion of pulmonary vesicles - alveoli, through which oxygen is exchanged. The development of this condition is facilitated by the massive entry of stagnant amniotic fluid into the lungs, which occurs during the respiratory movements of the fetus.
- Irreversible damage to brain tissue also often occurs - hemorrhages or ischemic strokes associated with a lack of oxygen and pressure from the dense bones of the skull. If they are extensive, they lead to the rapid death of the child.
- Due to the dissolution of vernix lubrication on the skin, which contains protective factors, post-term babies are susceptible to infection. The most dangerous is widespread exfoliative dermatitis, leading to the formation of multiple blisters throughout the body.
Despite the initially normal development of the fetus, prolonged exposure to oxygen deprivation makes it a target for a variety of fatal conditions.
Remote
If pathological mechanisms have not had time to seriously harm the fetus, they can still manifest themselves over time in the form of various diseases. Often they can seriously affect health, causing developmental delays:
- The most commonly observed lesions are from the nervous system - cerebral palsy, lesions of peripheral nerves and spinal cord. These diseases can remain at the same level throughout life, or initially progress, leading to a serious slowdown in physical, mental and mental development.
- Lung damage due to contaminated water is often manifested by frequent respiratory infections in childhood. Such babies regularly suffer from pneumonia or bronchitis, which causes the appearance of bronchiectasis - local dilation of the bronchi.
Intrauterine hypoxia also seriously affects the state of the immune system - such children are subsequently characterized by low resistance to infections. And slower physical development leads to frequent damage to the musculoskeletal system (scoliosis, flat feet).
- Nutrition and physical activity of expectant mothers
If your pregnancy has already reached the 41st week, and the long-awaited birth is not about to begin, do not panic. This situation, according to our expert, occurs quite often - in about every tenth woman.
Victoria POPOVA, Candidate of Medical Sciences, multidisciplinary obstetrician-gynecologist, talks about what causes differences in the timing of pregnancy in different women and what period is still considered optimal for childbirth. medical center"Professor Pasman's Clinic."
What is the normal length of pregnancy
The average duration of a full-term pregnancy is 280 days (40 weeks), or more precisely 38-42 weeks from the 1st day of the last menstrual period, or, on average, 266 days from the moment of ovulation with a 28-day menstrual cycle. But, given that each pregnancy is individual, there is no point in talking about post-term pregnancy at 41 weeks. It should be perceived as a period of waiting for childbirth.
How to set your expected due date
There are several ways to help calculate the length of pregnancy.
The obstetric method (based on the date of the last menstruation) is the most common.
The main figure from which the countdown is based is the date of the start of the last menstruation. To do this, the Naegele formula is used, according to which nine full months and one week are added to the date of the last menstruation.
Important! An even simpler calculation can be made if you subtract three full months from the start date of your last period and also add one week.
Expert commentary
This is how the pregnancy period is calculated, but not the conception period, since at the time of the onset of menstruation, pregnancy has not yet occurred. This means that with a 40-week calendar, actual conception occurs only in the third week (after all, ovulation on average can occur on the fourteenth to fifteenth day after the end of menstruation), and therefore the gestational age of the child will be approximately two to three weeks less.
When calculating the obstetric gestational age, only the average duration of the menstrual cycle with ovulation in the middle (on the fourteenth to fifteenth day) is usually taken into account. If you have irregular periods, disruptions in your cycle, it lasts more or less than twenty-eight days, you will have to take all these nuances into account. For example, if your cycle is larger, then add to the proposed calculation required quantity days, and if less, subtract.
Embryonic method (by date of ovulation and conception).
This method of calculating the date of birth and determining the duration of pregnancy can be used if you know exactly not only the day and time of conception, but also the day and time of maturation of the egg.
The day of conception (known or suspected) corresponds to 2 full obstetric weeks of pregnancy, i.e. on the first morning after successful intercourse, the gestational age is... 2 weeks and 7 hours! The duration of pregnancy from this date will be about two hundred and sixty-six days or thirty-eight weeks. But this method is almost never used, because few expectant mothers will be able to provide the doctor with such accurate information.
Ultrasonography
Most effective method determining the gestational age (this is the name of the period from fertilization of an egg with a sperm to the birth of a child) - ultrasound examination in the first trimester (measuring the diameter of the gestational sac up to 6 weeks, and then measuring the coccygeal-parietal size of the fetus (CPR) up to 14 weeks).
Expert commentary
Routine ultrasound in the first and second trimesters of pregnancy has made it possible to significantly reduce the frequency of previously recorded post-term pregnancy. It is important to remember that the earlier the ultrasound is performed, the more accurately the gestational age can be determined. Measuring the CTE of an embryo in the first trimester makes it possible to obtain the most exact date pregnancy with an error of ± 3-5 days.
Determining the period by KTP after 12 weeks becomes less accurate. And errors in determining the due date according to ultrasound data in the third trimester already increase to 3-4 weeks!
A bimanual examination based on the first appearance at the antenatal clinic in the first trimester, unfortunately, does not allow one to accurately determine the duration of pregnancy - the error is 2-3 weeks.
41 weeks: post-term or not?
At the 41st week, a woman will not be able to accurately differentiate between a post-term pregnancy and a normal pregnancy. Such a fairly common example in the literature as a sharp decrease in abdominal circumference due to a decrease in the amount of amniotic fluid is an extremely rare phenomenon, but even for a pregnant woman it is quite problematic to detect it. Therefore, the expectant mother is unlikely to be able to adequately assess the situation - this is the direct task of obstetricians and gynecologists; All mothers should learn this so as not to expose themselves to unnecessary and, often, groundless worries. In any case, there is no need to worry until the full 41st week; if the pregnant woman and the fetus are in satisfactory health, you can safely carry the pregnancy to term until its completion.
“Much more important than determining the exact date is the correct assessment of the readiness of the cervix. If it is soft and shortened, then you can safely wait until the end of 41 weeks. If the cervix is not ready, then the pregnant woman is hospitalized in an obstetric hospital in order to have time to prepare the cervix, which will allow for a successful delivery at 41-42 weeks.
Unfortunately, it is not uncommon for a pregnant woman at 42 weeks to be admitted to the hospital with an unprepared cervix, and the baby also has all the signs of postmaturity according to ultrasound. All that remains is to resort to a caesarean section...
So at the borderline period (estimated 40 weeks), the doctor must assess the condition of the birth canal and make a decision - to allow the expectant mother to stay at home until the full 41st week or to hospitalize her to prepare for childbirth.
What kind of pregnancy is called post-term?
A pregnancy is considered post-term if its duration is 42 weeks or more of the gestational (menstrual, obstetric) period. Accordingly, childbirth during such a pregnancy is called late.
” A child born during such a pregnancy quite often (but not always!) has signs of “overmaturity,” although both delayed births without signs of fetal overripeness and timely births with an overripe fetus occur.
Thus, “postmaturity” is a calendar concept, and “overripeness” refers to physical status fetus and newborn.
Expert commentary
The diagnosis of postmaturity is confirmed by examination of the fetus and placenta. The presence of at least 2-3 of the following signs indicates overripeness of the fetus:
- weak expression of subcutaneous fatty tissue;
- absence of caseous lubrication;
- intravital maceration of the skin (“bath palms and feet”);
- dense skull bones, narrow sutures and fontanelles;
- meconium-stained skin, newborn umbilical cord, membranes and amniotic fluid;
- long nails in a newborn;
- lack of vellus hair;
- decrease in skin turgor (elasticity).
Why does labor not begin on time?
And yet, why does labor, expected according to the most accurate calculations, not begin? Unfortunately, the reasons for post-term pregnancy are still not clear. Postmaturity can be repeated with each subsequent pregnancy.
” In primiparous women over 30 years of age, post-term pregnancy is observed much more often.
Significant factors leading to post-term pregnancy relate to the fields of neurology and endocrinology. Changes in the uterus that reduce its excitability and contractile activity are of a certain importance: insufficient number of receptors for oxytotic substances, impaired synthesis of contractile proteins in the myometrium.
” This is often associated with previous abortions and inflammatory diseases.
Expert commentary
In postmaturity, the role of autoimmune pathologies, endocrine and metabolic disorders, and even emotional tension is important. Important have delayed maturation of the placenta, chronic placental insufficiency, as well as preservation of placental immunological tolerance, which prevents immunological rejection of the fetus at birth.
” - In case of severe postmaturity, there are no killers in the blood of pregnant women against fetal cells. One of the reasons for changes in immune status may be genetically determined compatibility of mother and fetus (consanguineous marriage), which contributes to prolonged retention of the fetus in the uterus.
Developmental defects of the central nervous system of the fetus may also be reasons for postterm pregnancy. They are accompanied by a decrease in the synthesis of corticosteroid hormones, on which the cascade release of prostaglandins and the development of labor depend. During postterm pregnancy, fetal malformations are observed 10-15 times more often than during full-term pregnancy.
Medical tactics for post-term pregnancy
Active tactics for managing pregnancy and childbirth during postterm pregnancy made it possible to reduce perinatal mortality by 2-3 times. What is active tactics? At 40 weeks of pregnancy, the pregnant woman is recommended to undergo an examination: if the condition of the fetus is satisfactory, a delay from hospitalization is given until 41 weeks, during which the physical activity of the fetus is recorded, and fetal fetometry.
” In case of uncomplicated pregnancy and the absence of significant risk factors, hospitalization earlier than 40.5-41 weeks is not advisable.
Postmaturity poses a certain danger to the baby, and therefore further, at the 42nd week, the pregnant woman must be hospitalized to monitor the condition of the fetus. However, this does not mean at all that she will certainly be operated on right away! On the contrary, all efforts of doctors are aimed at natural delivery, because post-term pregnancy is a relative, and not a mandatory, indication for surgical intervention.
But if there are other aggravating factors: “immaturity” of the cervix, fetal hypoxia, various maternal diseases and age over 30 years (if this is the first birth), then the issue can be resolved in favor of a planned cesarean section.
Post-term pregnancy
Nine months have passed. And your baby is in no hurry to be born. Why? So what should mom do?
Many women who do not go into labor after 40-41 weeks experience anxiety. Each new day seems to drag on forever. They complain: “One day is like a whole week!”
Mommy should calm down, but how can you relax here? Doctors scare me with problems with the child and induction of labor. The thought is tormenting you, isn’t it too much to bear?
Relatives are worried and friends and acquaintances call with enviable regularity with the question: “Well, who should I congratulate you with?”
Post-term pregnancy?
First, let's decide on the deadlines. A normal, average pregnancy falls within fairly wide boundaries: 40 weeks from the first day of the last menstruation (or 38 weeks from the date of conception), plus or minus 2 weeks. And since most women cannot remember the exact day of conception, it is customary to focus on 40 weeks.
Childbirth at 37-42 weeks is not considered early or late. A pregnancy that lasts 42 weeks or more and ends with the birth of a normal, full-term baby without signs of overmaturity is called prolonged. It occurs half as often as postmaturity. In any case, there is no need to panic.
Each woman has her own upper limit of normal due date. What defines it?If the menstrual cycle is more than 28 days (from the first day of one menstruation to the first day of the next), then a pregnancy of more than 40 weeks is normal.
At the same time, the more days in the cycle, the longer you can walk without fear. For women with a cycle of less than 28 days, a 36-40 week pregnancy is normal.
If the first trimester of pregnancy was accompanied by any complications, there is a possibility of its extension without signs of postmaturity. In this case, the child seems to be gaining what he did not receive in the early stages.
If someone in the family of the expectant mother carried a child longer than 40 weeks, then with some degree of probability we can expect this to happen to her as well. There is a hereditarily determined biorhythm of the intrauterine development of a child, and therefore the onset of childbirth.
If a woman has set herself to give birth, for example, when her husband returns from a business trip or the doctor returns from vacation, her body can adapt to this condition.
But there are still cases of actually post-term pregnancy. This situation usually requires quick delivery, and labor should not be rushed to begin.
- A sharp decrease in the volume of amniotic fluid is a prerequisite for the development of weak labor.
- The absence of “anterior waters” (the so-called “flat bladder” that covers the baby’s head) inhibits labor and slows down the dilation of the cervix.
- An immature cervix at 40 weeks indicates a high probability of post-term pregnancy.
- The dense bones of the child's skull, narrow sutures and fontanels make the pushing period more difficult - it will require much more effort from mother and baby.
- The absence of cheese-like lubricant flakes in the amniotic fluid (according to ultrasound data) indicates dry skin of the child, which indicates overmaturity.
- Signs of placenta aging, which are easily detected on ultrasound, indicate that the placenta can no longer cope with the needs of a growing child.
- Amniotic fluid cloudy from meconium (the baby's first intestinal secretions) (according to ultrasound data) indicates oxygen starvation of the child.
Reasons for post-term pregnancy
What are the reasons behind post-term pregnancy?
Medical aspect of post-maturityDoctors believe that the basis for post-term pregnancy is the lack of “biological readiness” of the mother’s body for childbirth. This occurs due to dysfunction of the central nervous system of mother and child and (or) the regulatory function of the placenta.
Immaturity of the fetal immune system, deficiency of vitamins C, P, E and group B also contribute to post-maturity, as do endocrine diseases, fat metabolism disorders, abortions, some diseases of the genital organs, and mental trauma.
Heredity also plays a role: if someone in your family has had multiple pregnancies, there is a possibility of post-term pregnancy. Clinical blood and amniotic fluid tests can confirm hormonal imbalances and disturbances in intracellular energy processes.
But too much medical control in itself can also delay delivery. The so-called “biological unpreparedness” for childbirth in most cases is a consequence of certain problems and fears of the mother. Therefore, labor can be stimulated by both medical and psychological means.
Psychological aspect of post-maturityLabor may not begin due to various fears of the mother. For example, the threat of termination of pregnancy often leads to the fact that she begins to behave in such a way as to minimize all processes that provoke miscarriage or premature birth. This is very good for pregnancy, but it interferes with childbirth.
Prenatal processes such as increased tone of the uterine muscles, heralding contractions, softening and smoothing of the cervix are associated in a woman’s mind with the fear of losing a child.
To stimulate labor, include in your life all those activities that were excluded during the period of danger: long walks, walking up the stairs, gymnastics, swimming. Don't neglect intimate life. In a word, relax and prepare yourself for childbirth!
Unconscious fears before childbirth are not uncommon. They work productively with fears in prenatal training courses, and individual consultations with a psychologist will also help. If the expectant mother led a very active lifestyle throughout her pregnancy, and shortly before giving birth she relaxed and began to enjoy herself, the pregnancy may be delayed.
Everything is fine on time and before giving birth it is normal to experience no fatigue from pregnancy. Constantly monitoring the symptoms of impending labor can be too intrusive. It prevents labor from starting on time.
Distract yourself from waiting by planning and implementing some things. For example, it’s good to start preparing a dowry for a child, to bring the “family nest” to shine, to take a long walk every day or go on a visit.
Very often, relatives rush things and infect future parents with their anxiety. If anxiety intensifies, it would be useful to consult good specialist or going to an ultrasound to determine the presence or absence of signs of an actual post-term pregnancy. If they are not detected (even at 41-42 weeks), then there is still time.
The most obvious factor requiring quick intervention is the presence of meconium suspension in the amniotic fluid (according to ultrasound) and a deterioration in the child’s heart rate. Then it is useful for the mother to even be a little afraid for the baby so that labor can begin. In any case, professional medical supervision and possibly drug induction of labor are required.
Discuss the problem of post-term pregnancy family council with your spouse and other adult family members. In such a conversation, you can express your accumulated feelings and experiences and learn about the feelings of others.
It happens that the future father's fear of childbirth and the birth of a child creates a feeling of uncertainty in a woman - especially if she is used to being charged with this confidence from her husband. Then a sincere and confidential conversation, and sometimes even a showdown (with obligatory reconciliation, of course) will have the desired and long-awaited therapeutic effect.
Mammary test
This test is to determine readiness for childbirth.Sit or lie down in a comfortable position, relax, and place your watch next to you. Stir the nipples and areolas with your fingers 5-6 times for 1 minute every 3 minutes. To track contractions, place your hand on your stomach.
Results:- The test is considered positive if uterine contractions appear in the first 3 minutes from the onset of nipple irritation and there are at least 3 contractions within 10 minutes.
- If the test is negative by 40 weeks, there is a tendency to carry the pregnancy to term.
- If the mammary test is clearly positive (after just a minute of stimulation the uterus reacts with active contractions), but labor for some reason does not begin, it means that the baby needs to sit in the mother’s tummy for a little longer. Labor will begin as soon as the baby is ready to be born.
Why is postterm pregnancy dangerous?
Post-term babies have increased sensitivity to lack of oxygen due to the high degree of brain maturity. If the placenta does not provide the baby with sufficient oxygen, he may develop a serious condition.
Dense skull bones adapt less well to the mother's birth canal, which increases the risk of birth trauma. Post-term babies often experience a complication such as aspiration of amniotic fluid (retention of amniotic fluid in the lungs).
