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What is dangerous post-term pregnancy. Overweight baby. Signs of such. Symptoms and consequences

A baby born after 41-43 weeks of pregnancy is considered post-term. These babies have pronounced symptoms of overmaturity, so babies require close attention and special care.

Determine if a newborn is overdue or not characteristics, some of which require emergency resuscitation of the baby. The symptoms of a child's transition are as follows:

  • a greenish tint to the skin, hair, under the nails (this indicates the release of meconium in amniotic fluid);
  • aspiration of meconium in a newborn;
  • too much long nails on the hands of the baby;
  • signs of asphyxia;
  • noticeable peeling of the skin and lack of original lubrication;
  • the baby may have too thick and long hair;
  • an increase in the circumference of the chest, bulging nipples;
  • dense skull bones (this often causes birth trauma both mother and child)
  • thin umbilical cord (the navel falls off after 1-2 weeks, while in newborns born on time, this happens on the fourth or fifth day).

    • Note! A post-term newborn with symptoms of meconium aspiration or bouts of asphyxia is immediately resuscitated and then observed in the intensive care unit.

    overripe babies after recovery period often ahead of their peers in development, are very active, busting in weight is possible. You can see in more detail how post-term newborns look in the photo.

    Why are overripe babies born?

    In fact, scientists have not yet figured out the reliable reasons why newborns are born overripe. Neonatologists associate this with a genetic predisposition, as well as the mother's tendency to chronic diseases (diabetes, bronchial asthma).

    There is also a risk of over-carrying the baby with a large number of previous pregnancies (4-5) or if the first child was born large enough. The immaturity of the placenta is also considered a negative factor: it is likely that it will remain young, and the baby has already matured.

    The kids are talking! The other day I scolded my son (4 years old). He sat, listened, then gave out:
    - Mother!!! Well, you must understand that if you swear so much, the child will not love you!

    However, do not panic if you have some indications that provoke the delay of the pregnancy. In most cases, babies are born healthy and perfectly adapt to the external environment.

    Post-term newborn: features of care

    If a newborn child is overripe, it is necessary to provide him with first aid immediately after birth. Caring for a post-term baby is not difficult, unless it requires resuscitation. The principle of care is the same as for babies born at term.

  1. Immediately after birth, the child is assessed on the Apgar scale (if necessary, clean respiratory tract from meconium and around amniotic fluid).
  2. If an allergic rash appears on the skin of an infant, an injection of Dimedrol may be prescribed to the baby (it helps to relieve the symptom, helps the child sleep if he is restless).
  3. Dry skin of a post-term newborn should be treated with a moisturizing baby cream or oil (be sure to use cosmetics while swimming).
  4. With early closure of the fontanel, it is worth stopping taking solutions containing vitamin D (prescribed for the prevention of rickets).
  5. It is better to change the diaper more often than usual (once every two hours), while washing the baby well and blotting every crease with a diaper. To prevent diaper rash, it is better to use baby powder under the diaper.
  6. Hardening procedures should be practiced (more often leave the newborn naked to take air baths walk in the sun and fresh air).
  7. Keep as long as possible breast-feeding, do not be afraid to apply the baby on demand, wait until the baby releases the breast on its own - do not take it out by force.

    A mother's love and care will help a child grow up happy and healthy with their peers.

    Danger to the life and health of the child

    Often, there is a danger to life in post-term newborns if hypoxia was diagnosed after birth. Obstetricians found that the baby, who is overripe, does not tolerate oxygen starvation resulting in the following complications:

    • weight loss, dehydration in the first weeks of life;
    • the presence of hormones in the blood changes (the amount of prolactin, cortisol decreases);
    • brain function in a child may suffer (poor emotional and mental development).

    At right approach to the treatment of post-term newborns (if they require it), it is possible to avoid the consequences of overmaturity of the child.

Bearing a fetus is not an easy task, because during the entire period of pregnancy, the baby and future mom are at risk of developing many problems and complications. One of these complications is post-term pregnancy, when, after the expected delivery time, the child remains in the womb and is in no hurry with its birth. With a post-term pregnancy, certain consequences are almost always observed both for the woman in labor and for the child.

The incidence of this pathology is about 8-10%, and some sources speak of 42%. Prolongation of pregnancy significantly increases the rate of neonatal morbidity and perinatal mortality, bringing both rates to 29%.

The etiology of the term "postterm pregnancy"

At normal flow pregnancy, it lasts 280 days or 10 obstetric months (which is 40 weeks). A post-term pregnancy is one that lasts 42 or more weeks and ends with the birth of a child with signs of overmaturity. However, overmaturity does not always end with the birth of an overripe child, in other words, “overmaturity” and “overmaturity” are not synonymous.

Childbirth in case of pregnancy overdose is called belated. It is possible that a late-born baby will not show signs of overmaturity, while there is a chance of an over-ripe baby being born at term. Considering the above, it becomes clear that pregnancy overdose is a calendar concept, while the overmaturity of the fetus is based on an assessment of its physical status after birth.

Classification of post-term pregnancy

Postterm pregnancy is divided into two types:

    biological, or true, overmaturity - a situation where, in addition to delaying the date of birth by 10-14 days, a child is born with signs of overmaturity;

    prolonged pregnancy, or false gestation - despite the fact that the duration of gestation increases by 2 or more weeks, the child is born without manifestations of gestation, functionally mature, and there are no signs of aging in the placenta.

However, in modern obstetric clinics, the term "prolonged pregnancy" has not found a place, nor is it in the international classification of diseases. Therefore, the following classification is more often used:

    if the gestational age is more than 40 weeks, but does not exceed 40 weeks and 7 days (in other words, 41 weeks), the pregnancy is considered full-term and the birth is timely, respectively;

    if the pregnancy exceeded 41 weeks, but did not exceed 42 weeks, one should speak of a “tendency to overbearing”, but at the same time, the birth is called timely (the definition of “41+” is also quite often used);

    if the period of gestation corresponds to the full 42 weeks and exceeds them, the concept of "postterm pregnancy" is used, childbirth in such cases is called belated.

Factors affecting the term of childbirth

When calculating the estimated date of birth, the duration of the menstrual cycle must also be taken into account. For example, if the duration of the menstrual cycle is more than 28 days, then childbirth may be present after reaching the mark of 40 full weeks(prolonged pregnancy). Thus, the longer the menstrual cycle, the longer the pregnancy will take. Women with a short menstrual cycle (less than 28 days) may be ready for childbirth as early as 36 weeks.

Factors contributing to overdose of pregnancy

Preterm pregnancy may occur due to exposure a large number factors, however main reason The occurrence of such a complication of pregnancy is a violation of neurohumoral regulation in the mother's body, since it plays a major role in the formation of the generic dominant. In other words, the main role is played by functional disorders in the brain, and the emergence hormonal imbalance(hormones that are starters labor activity: prostaglandins, serotonin and histamine, placental lactogen and progesterone, hCG and estrogens).

However, in a number of cases, the occurrence of overdose of pregnancy does not originate in the state of the mother's body, but in the presence of pathology of the placenta or fetus. Depending on this fact, the factors that provoke overbearing are divided into two groups: maternal and fetal.

Changes in the mother's body:

  • heredity (pregnancy was present in the woman's family);

    ovarian dysfunction;

    inflammatory processes in the genital organs (salpingoophoritis, endometritis, cervicitis);

    uterine tumors;

    general and sexual infantilism;

    disturbed menstrual function;

    history of childhood infections (scarlet fever, measles, and others);

    transferred SARS or influenza during gestation;

    infantilism;

    pathology of the liver and diseases of the digestive tract;

    endocrine pathologies (obesity, diabetes mellitus, diseases thyroid gland);

    history of brain injury;

    fear of losing a child and fear of childbirth;

    stress and mental trauma;

    age (first birth after reaching the age of 30);

    drug therapy for the threat of termination of pregnancy (current);

    hypodynamia during pregnancy;

    childbirth large fruit in history;

    numerous abortions.

Changes in the body of the fetus:

    Down's disease;

    adrenal hypoplasia;

    breech presentation;

    pathology of the child's kidneys (polycystic);

    failures in the development of the pituitary-adrenal system;

    malformations of the brain (microcephaly, dropsy of the brain, anencephaly).

The pathogenesis of overdose of pregnancy

The placenta and the changes that occur in it play essential role in the mechanism of development of post-pregnancy. Overmaturity may be due to dissociated or delayed maturation of the placenta, the presence of chronic placental insufficiency, or the preservation of immunological tolerance in the child's place, which prevents the occurrence of immunological reactions that are aimed at rejecting the fetus in the prescribed time frame.

The resulting dystrophic and trophic changes in the decidua and amnion lead to a disruption in the synthesis of the hormone prostaglanlin, which is involved in labor. There are also hormonal imbalances in common system called fetal-placental-maternal. There is a change in the ratio of gonadotropic hormones, the content of catecholamines increases, chorionic gonadotropin and progesterone, which leads to overweight.

Macroscopically, the mass of the placenta is increased, although its thickness is reduced. The chorion itself is dryish, with weak differentiation into lobules. Also, the placenta begins to stain with green waters (due to fetal hypoxia, meconium is discharged). All over the area children's place there are calcifications and white heart attacks, places of fatty degeneration.

Changes also affect the amniotic fluid. Amniotic fluid changes its composition and loses its former transparency. If the overgestation is insignificant, the waters have an opalescent hue, become whitish, as the skin epithelium and the cheesy lubricant of the fetus begin to dissolve in them. If fetal hypoxia occurs, the water turns yellow or green color.

There is a change in the phospholipid composition amniotic fluid. The content of sphingomyelin and lecithin, which are responsible for the formation of surfactant (a substance that prevents the lungs from collapsing during inhalation) in the lungs of the fetus, is disturbed. Against the background of a violation of the synthesis of surfactant, an overripe fetus receives a respiratory distress syndrome, hyaline membranes are formed in the lungs.

Change physical and chemical properties and a decrease in the volume of amniotic fluid leads to a decrease in their bactericidal activity, the number of bacteria that contribute to the development of intrauterine pneumonia in a baby is growing.

Volume reduction amniotic fluid with a post-term pregnancy, it occurs in direct proportion to the time of overgestation:

    the volume of amniotic fluid in the full 41 weeks is reduced by 100-200 ml and is, respectively, 600-700 ml (normally, the amount of water is 800-900 ml);

    the volume of amniotic fluid in the full 42 weeks is halved and is 350-400 ml;

    in the full 43 weeks, the amount of water is greatly reduced (up to 200-300 ml), which leads to the development of severe oligohydramnios;

    in the case of a significant prolongation of pregnancy (44 full weeks or more), there is practically no water, the volume is 40-60 ml.

Clinical picture

In the presence of a post-term pregnancy, the following symptoms are characteristic:

    the circumference of the abdomen loses about 5-10 cm due to dehydration phenomena (in case of overwearing for more than 10 days);

    the elasticity of the skin of the expectant mother decreases;

    the uterus acquires density due to the contraction of muscle fibers and a decrease in the amount of water;

    oligohydramnios;

    the height of the uterine fundus increases due to the large size of the fetus and hypertonicity of the uterus;

    milk appears instead of colostrum;

    there is weight loss in a pregnant woman, or weight gain stops;

    "immaturity" of the cervix;

    oxygen starvation of the fetus (decrease in biophysical profile: fetal tone decreases, respiratory movements, movement);

    the nature of the child’s heart rhythm changes when listening (heartbeat slows down / quickens, heart tones become muffled or muffled), this indicates the development of fetal hypoxia against the background of placental insufficiency;

    the density of the child's cranial bones (ossification) increases, fontanelles and sutures become narrow and begin to grow together (determined during vaginal examination).

Appearance of an overripe fruit

Belated childbirth leads to the birth of a fetus with signs of overmaturity:

    dense bones of the skull, may be closed seams and fontanels;

    skin is yellowish or greenish color(due to meconium dissolved in the waters);

    long hair;

    long nails on the toes and hands (overcome the edges of the nail phalanges);

    subcutaneous fat layer is less than normal;

    there is no original lubrication, as a result of which wrinkling of the skin occurs;

    the birth of a hypotrophic fetus is possible (as a result intrauterine delay growth);

    the length of the fetus exceeds the norm (from 56 cm or more);

    large sizes (the size of the child's head corresponds to the upper limit of the norm or exceeds it).

Degrees of overwear

The intrauterine state of the child largely depends on how long the period of postmaturity is, on the basis of this, the following degrees of postmaturity are distinguished:

    First degree.

The gestation period is a full 41 weeks. The child's condition is satisfactory, but there is an increase in heart rate and motor activity. The volume of amniotic fluid is reduced, but slightly (600-800 ml), their color is whitish and opalescent.

The cervix at the end of pregnancy is not mature enough, compacted, internal os is a dense cushion. The head of the fetus is pressed against the pelvis loosely. Macroscopically, the placenta has a full-term appearance. The newborn has slight signs of overmaturity.

The skin of the child is dryish, but not wrinkled, and there is a small amount of cheese-like lubricant. The length of the newborn is 54-58 centimeters.

    Second degree.

In most cases, it corresponds to 42-43 weeks. The biological readiness of the cervix for contractions in a woman is absent, the circumference of the abdomen decreases every day by 1-3 cm, there is an increase in the intrauterine fundus. The head is not pressed against the entrance to the bone pelvis. Starts to develop placental insufficiency and fetal oxygen deprivation. Heart rhythms are muffled, and during the movement of the child they become less frequent or more frequent. Movements, in turn, become rare, however, deep respiratory movements are determined on ultrasound, which sometimes turn into convulsive ones.

According to ultrasound:

    decrease in intraplacental blood flow;

    increased echo density of waters;

    pronounced oligohydramnios;

    maturity of the placenta of the third degree.

Macroscopically: the delimitation of the lobules is erased, the placenta is dryish, thin.

The volume of water decreases significantly, while they become cloudy and whitish. In childbirth, the inferiority (plane) of the fetal bladder is noted, its membranes are dense and stretched in the area of ​​\u200b\u200bthe head of the child. The newborn has clear signs hypoxia and overmaturity.

    Third degree.

A very rare degree of overgestation, in which the pregnancy exceeds 43-44 weeks. The umbilical cord in the fetus is thin, the skin is yellow or green, multiple organ failure develops. The area of ​​the placenta is not increased, but its thickness is reduced, there are multiple white heart attacks and calcifications. The placenta also has a yellow-green color.

Significantly increases the likelihood of intra- and antenatal fetal death, as well as early infant mortality.

Diagnostics

Diagnosis of post-term pregnancy begins from the moment the exact timing of gestation is established. To do this, use all methods for calculating the estimated date of birth:

  • by date of registration (first visit to women's consultation about pregnancy)

    counting from the first movement of the fetus;

    countdown from the day of ovulation;

    countdown from the day of fertilization;

    by last menstrual date.

Palpation of the uterus and gynecological examination in the first trimester allows you to accurately determine the duration of pregnancy. Also, when calculating the timing, the date of the first positive test for pregnancy, the day of raising the uterus to the level of the navel (corresponding to the period of 20 weeks), the day of the first listening to the heartbeat (at 18 weeks with a stethoscope and at 12 with a doppler).

During the execution of the objective obstetric research an increase in the height of the uterine fundus and a decrease in the circumference of the abdomen are diagnosed. Weight loss or slight gain is also noted. Against the background of oligohydramnios, the mobility of the child also decreases.

In the course of a vaginal examination, the absolute unpreparedness of the cervix for contractions, the narrowing of the fontanelles and sutures, and the dense bones of the child's skull are determined. The presenting part of the fetus is either not pressed tightly to the entrance, or is mobile and is located high above the entrance to the small pelvis.

Instrumental Methods

Of the instrumental methods are widely used:

    Dopplerography.

With the help of dopplerography of the blood flow between the placenta and the uterus, the presence of signs of aging of the child's place is revealed: perfections and calcifications, thinning (weight loss) of the placenta, a decrease in the intensity of the uteroplacental and fetoplacental blood flow.

    Cardiotocography.

With the help of CTG, bradycardia (less than 120 beats per minute) is determined, as well as tachycardia (more than 160 beats per minute), which confirms the presence of fetal hypoxia.

    Amnioscopy.

Study of the nature of the amniotic fluid through the cervical canal and fetal bladder. Yellow or greenish waters are observed.

    Amniocentesis.

After receiving a small amount of water, a study of their composition is performed. The water contains a high content total protein and lactic acid, urea and creatinine, as well as lowering glucose levels. The first sign of overgestation is a change in the ratio of lecithin and sphingomyelin - 4/1, while in a mature fetus this ratio is 2/1.

    Ultrasonography.

During the ultrasound, the height of the child is measured and its weight is calculated, it is also determined increased density skull bones and the presence of intrauterine malformations, the amount of fetal water and oligohydramnios is determined. Suspension is present in the waters (increased echo density of the liquid), there is a decrease in the biophysical profile, signs of centralization of blood circulation, and intraplacental blood flow decreases. An assessment of the degree of maturity of the placenta is also performed (in the case of overbearing, the degree is the third).

Consequences of overwearing

Postponed pregnancy negatively affects the condition of the child, leads to complications during pregnancy and childbirth. At the end of the gestation period, overwearing is often the cause of anemia and preeclampsia in women. In addition, there are disorders in the blood coagulation system and oligohydramnios, which has a pathological effect on the fetus and the course of the birth process.

Features of delayed childbirth

Possible complications of late delivery:

    premature outflow of water with an "immature" or "insufficiently mature" neck;

    pathological preliminary period;

    obstetric injuries (ruptures of the soft tissues of the birth canal);

    protracted course of childbirth (lack of generic dominant and anomalies of labor activity);

    anomalies of generic forces (excessive density of the bones of the skull leads to a violation of its configuration, resulting in weakness of contractions or discoordination);

    the risk of infectious complications in the early postpartum period increases;

    the likelihood of bleeding in the third period of labor or the early postpartum period increases;

    premature detachment of the child's place or its increment (due to structural and metabolic disorders in the placenta).

Dangers for the fetus

Overbearing for the fetus is fraught with:

    hypoxia of the child during pregnancy or during childbirth (aging of the placenta causes fetoplacental insufficiency);

    asphyxia of the child in childbirth;

    birth injuries of the fetus (fractures of the limbs, intracranial hemorrhages and cephalohematomas due to a violation of the configuration of the head due to the dense bones of the skull);

    infectious processes of the skin and neurological disorders in the newborn;

    damage to the bronchopulmonary system (development of atelectasis, bronchopneumonia and other complications in a child after his birth);

    death of a child during gestation, during childbirth or in the early neonatal period.

The mortality rate of a child is directly proportional to the period of gestation. At 41-42 weeks, it is 1.1%, death at 43 weeks is recorded in 2.2% of cases, and with an extreme degree of overgestation - more than 44 weeks, the mortality rate rises to 6.6%.

Overwearing significantly increases the need to perform caesarean section. In addition, preterm children lag behind in mental and physical development in the future.

Obstetric tactics

Even during the management of pregnancy in the antenatal clinic, women with a tendency to overbearing are identified as a risk group, and upon reaching the period of 40-41 weeks, they are offered to go to the maternity hospital. The management of a post-term pregnancy consists in determining the readiness of the cervix for childbirth, monitoring the condition of the fetus and identifying pregnancy complications and the presence of extragenital pathology.

Postponement of pregnancy is included in the group of relative indications for abdominal delivery. A caesarean section is performed in the presence of concomitant factors:

    extension of the limbs of the child, extensor insertion of the head;

    entanglement of the umbilical cord;

    second and third degree of placental insufficiency;

    burdened obstetric history (pregnancy as a result of IVF, infertility, stillbirth in the past);

    first birth at age 30 or more;

    narrowing of the pelvis;

    presentation of the fetus with the pelvic end to the entrance;

    "immature" cervix.

If malformations that are incompatible with life are detected (during ultrasound), a fruit-destroying operation is performed.

After antenatal hospitalization in the maternity ward, a woman undergoes certain preparatory activities.

Improvement of uteroplacental blood flow

Against the background of aging of the placenta and partial loss its main functions are prescribed drugs that improve blood circulation in the uterus-placenta system: Cocarboxylase, Vitamins, Piracetam, Cavinton, Actovegin.

Formation of a generic dominant

The following physiotherapeutic procedures are used: darsonvalization of the mammary glands, acupuncture, vibration massage, collar according to Shcherbak and anodic galvanization of the brain.

Cervical preparation

Prostaglandins E2 are used to accelerate the maturation of the cervix. Prostaglandins are administered through the cervical canal as vaginal tablets, pessaries and gels. To soften and open the cervix, sticks - kelp - are also prescribed. In addition, a pregnant woman is prescribed a diet high in vegetable fat (since it contains prostaglandin precursors) and drugs that stimulate the synthesis of protoglandins (Essentiale Forte, Retinol, Linetol).

In the process of preparing the cervix, cardiotocography (monitoring of the fetal heartbeat) is performed daily for 5-7 days, as well as a Doppler study of blood flow in the mother-placenta-fetus system.

Birth management

If the cervix is ​​"mature", there are no aggravating factors and the fetus has a satisfactory general state, childbirth is carried out naturally. In the case of the development of a pathological preliminary period, ginipral is administered intravenously. Labor induction begins with the opening of the fetal bladder. If contractions have not started within 4 hours, intravenous infusion of prostaglandins is used. The process of childbirth is controlled by CTG, with parallel prevention of development intrauterine hypoxia(glucose with ascorbic acid, piracetam, cocarboxylase) and the introduction of antispasmodics with an interval of 3 hours. With the development of complications and deterioration of the fetus (insufficiently intense contractions, clinically narrow pelvis) delivery is completed by caesarean section.

FAQ

    I am 41 weeks pregnant. Can this be considered overkill?

No, but you should consult a doctor so that he recalculates the estimated gestational age using all methods and recommends hospitalization.

    Can sexual intercourse provoke contractions?

Yes. In case of overwearing, it is recommended to refuse intercourse. Firstly, male sperm contains prostaglandins that stimulate the maturation of the cervix, and secondly, during orgasm, the substance oxytocin is released, which stimulates uterine contractions.

    Is the aging of the placenta considered a sign of prematurity?

Almost always, when conducting an ultrasound scan, the aging of the placenta is determined in women with post-pregnancy. However, in some cases, aging of the placenta (in the 3rd degree of maturity) can also be diagnosed at terms of 27-32 weeks. This is not a sign of prolonged pregnancy, but indicates the presence of fetoplacental insufficiency.

In modern obstetrics, it is customary to consider a pregnancy delayed if its duration exceeds the accepted norm by two weeks. Such a pregnancy ends with a belated birth. True, not in all cases, postmaturity is associated with pathology, despite the fact that a woman carried a child longer than the normalized period, and the birth itself can be successful, and negative consequences not for the fetus either.

Reasons: prolongation of pregnancy

Normally, pregnancy lasts 10 obstetric months or 280 days, which is 40 weeks. A pregnancy that lasts longer than 42 weeks is considered post-term. Why exactly 42 weeks? Because the physiological norm is considered to be childbirth, which takes place in the period from 38 to 42 weeks. At the same time, it is important to understand: the concepts of a post-term or transitional pregnancy and an overripe fetus do not have an equal sign.

So, it happens that the child was born after 42 weeks of pregnancy, but he has no signs of overmaturity. Or, conversely, there may be a child born before the due date (preliminary date of birth), but with signs of overmaturity.

Possible causes of delayed pregnancy:

  • Endocrine pathologies;
  • Diseases of the digestive system and liver;
  • Previous brain injury;
  • Tumors of the uterus;
  • ovarian dysfunction;
  • Abortions in the past;
  • The threat of termination of this pregnancy;
  • Predicted large fruit;
  • Sexual and / or general infantilism;
  • Psychological problems (fear of childbirth, stress);
  • Physical inactivity.

A delayed pregnancy can also be hereditary - if in the family mother and grandmother, for example, “walked over”, there is a risk that the woman herself will have a delayed birth. Also, walking can be determined by reasons on the part of the child: these are some malformations of the brain, and pathology of the kidneys, and hypoplasia of the adrenal glands, and not even the most favorable breech presentation of the fetus. Also, a post-term pregnancy is often found in the case of the birth of a baby with Down syndrome.

Common signs of post-term pregnancy

It is possible to determine that the pregnancy is overdue by characteristic signs. There are some features that give out the fact that the pregnancy is overdue. And not always these signs coincide with the period, which is set by ultrasound.

Signs of a delayed pregnancy:

  • The circumference of the abdomen decreases by 5-10 cm due to dehydration (if overwearing is from 10 or more days);
  • Severe oligohydramnios;
  • The elasticity of the skin of a pregnant woman decreases;
  • The uterus is compacted due to the reduced volume of water, as well as contraction of the muscles of the uterus;
  • The density of the bones of the skull increases, fontanelles and cranial sutures become narrow and even grow together (this can be detected during vaginal examination);
  • The nature of the heart tones in the baby is changing, and this indicates fetal hypoxia;
  • Instead of physiologically normal colostrum, milk production begins;
  • The height of the uterine fundus increases due to hypertonicity of the uterus and large fetus.

The doctor takes into account all these signs, and also relies on other data that allow you to accurately diagnose the gestational age. This is not one indicator, but several at once - examinations in the first trimester with palpation, ultrasound, calculation of the date of birth according to the last menstruation, etc. In accordance with the condition of the pregnant woman and the fetus, the doctor decides whether it is possible to give the woman a chance to endure a little more and give birth herself, or whether it is worth starting the mechanism of labor stimulation.

Risks: what is the danger of prolongation of pregnancy

Usually, the fears of a pregnant woman are associated with premature birth. It is believed that a child who was born before the term is not so viable, there may be problems with his health, etc. But if the fetus is overdone, this is also not so harmless.

An important, rather dangerous moment is the aging of the placenta. It has its own degrees of maturity, and the higher they are, the less resources remain in the placenta. She becomes "old" and cannot help the baby develop and not experience discomfort inside the uterus. The child begins to suffer from oxygen starvation.

For the fetus, overcarrying is dangerous:

  • Hypoxia of the fetus itself (both during gestation and in birth process);
  • Asphyxia of the child in childbirth;
  • Neurological disorders of the newborn;
  • Birth trauma of the child (including intracranial hemorrhage);
  • Damage to the respiratory system.

Unfortunately, albeit a small percentage of fetal and newborn mortality, it still falls on the diagnosis of “post-term pregnancy”. If we talk about the extreme degree of postmaturity, and this is as much as 44 weeks or more, the mortality rate reaches more than 6%. Also, overwearing is a high probability that you will have to do a caesarean section.

The child may be diagnosed with Bellentine-Runge Syndrome - these will be signs of overripeness of the fetus. This is "senile-looking" skin, and long fingernails, and a greenish-yellow skin tone. There is very little or no cheese-like lubricant on the baby's body.

For a woman, delayed childbirth is also risky. If expectant mothers are walking, anomalies of tribal forces may occur - weakness of contractions and discoordination. Childbirth can be protracted, aggravated by obstetric trauma. There is a risk of placental abruption or placenta accreta, as well as infectious complications after childbirth.

What can be the consequences: post-term children

The anatomy of the fetus is such that its cranial bones begin to harden closer to the date of birth. They are no longer so flexible and mobile, and this is quite dangerous: during childbirth, the bones must adapt to the birth canal that they have to go through. But for this they must be mobile, the hardened bones of the skull will no longer be so flexible. If we remember that the child is also heavy weight childbirth becomes traumatic.

Unfortunately, it is not uncommon for post-term babies to swallow amniotic fluid containing meconium (the baby's original feces) during the birth process, and this is already a sign of fetal hypoxia.

Premature babies: consequences for the future:

  • If even after the birth of a child, he is not diagnosed with any problems and pathologies, they may be distant;
  • These are pathologies from the nervous system - cerebral palsy (cerebral palsy);
  • Lung injuries are common respiratory infections in childhood, bronchitis and pneumonia.

Intrauterine hypoxia is dangerous because the immune system the child is not working properly. It is distinguished by low resistance to infections. There may be some slowdown in physical development.

Why the pacing arose, whether the deadlines are set correctly - all this is not a subject of independent speculation. Obstetricians and gynecologists have their own tactics for managing and delivering a post-term pregnancy. Finally, there is prevention. possible pathology, and the doctor tells the pregnant woman about this in the first trimester.

Signs and consequences: post-term pregnancy (video)

How much longer to carry a child, whether it is necessary to stimulate labor - this will be decided not by someone, but by the attending physician, and, most likely, in the pregnancy pathology department. Tune in to the most successful outcome, trust the experts, lead a healthy and physically and mentally lifestyle during pregnancy.

Happy birth!

The most common concern for expectant mothers is premature pregnancy when a child is born before the due date, which may be due to various reasons. But not all women are aware of the danger of a post-term pregnancy, believing that a couple of extra days will not hurt the child. Is it so?

There are two types of post-term pregnancy: prolonged and true physiological. Normal pregnancy lasts about 280 days, that is, 40 weeks, you need to count from the first day of the last menstruation. If the baby is born 10-14 days later than the due date, such a pregnancy is considered post-term. However, in the case of prolonged pregnancy, the child is born normally healthy, without signs of placental aging, which indicate to us the true overbearing of the child. In the case of a physiological post-term pregnancy, the amount of amniotic fluid decreases and acquires an unpleasant brownish-greenish tint. The color of the waters changes as a result of the presence of fecal primordial masses in them.

Causes of post-term pregnancy

Exist various reasons that affect pregnancy, lengthening its duration. In most cases, prolongation of pregnancy occurs due to the wrong ratio of hormones - estrogens and progesterone. Violations hormonal background women may be associated with taking drugs, for example, to maintain pregnancy, changes in the functions of the thyroid gland, liver and kidneys, severe emotional shock.

If a woman had uneven menstrual cycle, this already indicates the malfunctioning of the systems, which can lead to problems during pregnancy.

The reason for overbearing a child can also be a sedentary lifestyle before and during pregnancy. The fact is that if a woman sat or lay a lot, the fetal head does not have time to fall down in time and create irritation, followed by childbirth.

Of course, abortions, other pathologies of female organs can also lead to an increase in the duration of pregnancy. Even previous pregnancy, at the birth of a child over 4 kg is also able to increase the time and the child will be born post-term.

Especially carefully this issue should be treated by women who have their first pregnancy over the age of 30, carefully monitor the course of pregnancy, be sure to take into account physical exercise, proper sleep, nutrition, Fresh air.

What can be dangerous overcarrying a child?

What happens to the fetus female organs at the end of pregnancy. At normal terms the course of pregnancy, placental atrophy gradually occurs, it is no longer able to saturate the fetus with everything necessary for normal functioning, therefore the baby does not receive the right amount oxygen, this is the worst thing, hypoxia may occur, the brain or nervous system of the unborn child may be damaged.

It is also very dangerous that during the period of overgestation of the child in the amniotic fluid appear stool that spoils the lungs of the child, disrupting the processes of normal life.

If a woman over-carries a child, it is more difficult for her to give birth, there is little amniotic fluid, there is little lubrication, and the child is most often larger, and his bones are harder, respectively, the child’s skull cannot shrink during childbirth, pinching of the skull may occur, which will affect brain activity, organs of vision and hearing, or lead to more serious consequences.

To prevent such serious consequences, many doctors decide to induce labor with the help of various methods, or a woman is given a caesarean section, which can save the health of both the child and the mother, but for this you need to know for sure that the pregnancy is becoming overdue. How to determine this, I will tell in the next article.

Features of childbirth during post-term pregnancy

Danger lies in wait for a woman and her child during childbirth, because more often than not, during a child's pregnancy, childbirth is usually difficult. What births are difficult? Those where there is a possibility of fetal damage, severe bleeding when the child can suffocate, and the woman is not able to give birth on her own.

Difficult childbirth during a post-term pregnancy is most often accompanied by:

  • early, premature release of amniotic fluid, which can lead to infections in the child, to suffocation, problems with the brain, organs of hearing, vision and breathing of the baby
  • weakness of labor, this is due to the fact that the organs that stimulate childbirth were not sufficiently excited, it is difficult for a woman to give birth on her own.
  • severe bleeding during and after childbirth, this is due to reduced contractile activity of the uterus, uterine ruptures, since most often the child is large, due to a violation of the process of placental abruption.

Diagnosis of post-term pregnancy

The fact that pregnancy can be too long today, doctors can say after the first ultrasound. They compare data on the last cycle of menstruation, on the first movement of the fetus and on its development.

In addition, studies are being conducted on the behavior and activity of the fetus, a decrease in activity and cardiac activity may indicate the possibility of a child overbearing. In addition, be sure to examine the head of the fetus, study its density.

On later dates pregnancy, especially if there is a suspicion of the possibility of a delayed pregnancy, amniotic fluid is studied. This procedure is called amnioscopy, a device is inserted into the cervix that examines the amniotic fluid, if they have a greenish tint, then they contain original feces. Which already indicates an abnormal development of pregnancy. This procedure is done only if the cervix can skip the device, that is, when it is ready for childbirth. This allows you to diagnose with absolute certainty the overbearing of the child.

Difficulties in childbirth during a post-term pregnancy

If it is already determined that the pregnancy has dragged on, the woman is hospitalized and prepared for childbirth. Sometimes it turns out to give birth on their own, but most often they stimulate childbirth, prepare the uterus for childbirth with special gels for several days. From the gel, the uterus softens, which allows for childbirth. Special preparations stimulate the uterus so that it begins to contract.

During a post-term pregnancy, difficult births most often occur. The obstetrician must constantly listen to the fetal heartbeat. In the first part of childbirth, it is necessary to listen to the baby every fifteen minutes, in the second part, when the woman begins to push more often and the contractions are regular - after each contraction. If there is a danger of fetal hypoxia - suffocation, then childbirth is accelerated. Or they decide on a caesarean section, but this is already determined by the obstetrician, based on the condition of the woman and the fetus.

If the birth was difficult, then postpartum monitoring of the baby and mother is performed to make sure that everything went well.

But a child is a miracle that gives joy, so a woman will survive even difficult childbirth so that the baby will one day call her mother.

At the first visit to the antenatal clinic, the obstetrician-gynecologist, after examining and specifying the day of the last menstruation, calculates and informs the woman of the expected date of birth (PDR). According to the results of fetal ultrasound in the 1st and 2nd trimesters of pregnancy, this date is specified and, most often, with a normal pregnancy and the development of the fetus in accordance with the gestational age, it remains unchanged. It happens that the due date has already come, and the baby has not yet been born. Prolongation of pregnancy is a rather serious complication, often leading to adverse results.

Postterm pregnancy is a pregnancy in which the duration of gestation is 42 weeks or more, and which ends with the birth of a fetus with signs of overmaturity and pathological changes in the placenta. There is a concept of chronological re-carrying of pregnancy for 2 weeks or more, but in this case the child is born without signs of overmaturity, and such a pregnancy is called prolonged. However, this option is 2 times less common.

Previously, the diagnosis of post-term pregnancy was often combined with wrong definition term and DA. Today, such errors are minimized thanks to the use of ultrasonic method research.

Why is this happening?

information Overdue pregnancy occurs in 4-14% of all pregnancies. The main reason why there is this situation, is a violation of neurohumoral factors in the mother's body in the regulation of the onset of childbirth.

In women with prolonged pregnancy, functional changes in the central nervous system(CNS), which indicate the absence of signs of the formation of the "dominant of childbirth". There are also changes in the level of hormones involved in the development of labor (estrogens, gestagens, hCG, placental lactogen, histamine, serotonin, prostaglandin, etc.).

Often the reason for the non-occurrence of labor is the placenta and the fetus itself, and not the inertia of the mother's body. Anomalies in the development of the fetus, especially the central nervous system, and pronounced changes in the adrenal glands lead to the fact that it does not produce the necessary primary chemical compounds that should turn into estriol in the placenta, a hormone that plays an important role in preparing the body of a pregnant woman for childbirth.

The placenta itself also takes a certain part in the prolongation of pregnancy. Circulatory disorders observed in it during pregnancy and by the end of the gestation period lead to its dysfunction: disruption of hormone production, gas exchange between the fetus and mother. An additional vicious circle of inhibition of the onset of labor is formed.

A hereditary factor cannot be ruled out, because pregnancy is a genetically determined process, which means it affects the time of onset of childbirth.

Somatic, endocrine and psychological diseases of the mother can affect the onset of labor. Complicated obstetric and gynecological history women (abortions, inflammatory diseases of the pelvic organs, menstrual dysfunction, preeclampsia) can also lead to the problem of prolongation of pregnancy.

What is the threat to the mother and fetus?

The most common fetal complication is hypoxia. The lack of oxygen occurs due to the fact that by the end of pregnancy, the physiological aging of the placenta occurs, and it ceases to cope with its functional duties. During hypoxia, the anal sphincters relax in the fetus and the original feces (meconium) enter the amniotic fluid, can be swallowed by the baby and enter the lungs during childbirth (meconium aspiration syndrome).

Children born after the 41st week of pregnancy are 2-5 times more likely to have severe CNS lesions. In 30% of cases, large children (more than 4-4.5 kg) are born, ossification of the skull bones occurs, which significantly increases the risks and incidence of complications and injuries to the fetus during childbirth. As you can see, post-term pregnancy is fraught with adverse consequences for the child. In addition, overdose increases the risk of morbidity and mortality in newborns.

important In most cases, such a pregnancy ends with a caesarean section. Its use is primarily due to the interests of the baby, since the overdue fetus is especially sensitive to oxygen deficiency. When delivering through the natural birth canal with a large fetus, complications often arise, both in childbirth and in the early postpartum period.

Maternal complications include ruptures II and III degree perineum, vagina and cervix, high risk development of hypotonic bleeding and postpartum infections.

What to do?

In modern obstetrics, an active tactic of managing such pregnancy and childbirth is common, which significantly reduces the number of complications and adverse outcomes.

According to this tactic, after 40 weeks of pregnancy, all women should be hospitalized for observation, examination of the fetus and the choice of a rational method of delivery. The decision on the method of choice of childbirth depends on:

  • the state of the fetus;
  • maturity of the cervix;
  • concomitant diseases;
  • history data.

With a mature cervix, labor induction is indicated, since some fetuses continue to gain weight after 40 weeks of intrauterine stay, which can lead to a mismatch in the size of the fetus and pelvis during childbirth (clinically narrow pelvis), and there is also a risk of sudden antenatal fetal death even against the background of complete well-being.

With an immature cervix and exactly deadlines pregnancy, you can try to wait until the spontaneous onset of labor or accelerate this process with the help of progesterone, laminaria, followed by labor induction (amniotomy, intradroplet administration of oxytocin).

Of course, in resolving this issue, it is best to trust the doctor, since the consequences of a delayed pregnancy can be too tragic.

You should not refuse hospitalization in a hospital. The purpose of hospitalization at 40.5-41 weeks is not to resolve the pregnancy as soon as possible, but to monitor the condition of the fetus, because overgestation poses a threat to his life.

Moreover, do not neglect medical advice at 42 or 43 weeks pregnant. Your baby's life is in your hands!