Why do they carry a baby for more than 40 weeks. Early childbirth - how to prolong the term and give birth to a healthy baby

Childbirth is already on the nose ... The woman is all in anticipation of a wonderful moment and slowly begins to panic: what if the birth occurs ahead of time. And slight painful sensations and tingling are ready to be perceived as the beginning of long-awaited contractions. But days pass, and characteristic pains are not observed.

Maybe it’s not about you and you don’t worry at all: so what, what already? In any case, it will be born, but how else? But this "otherwise" can be different. Therefore, we recommend that you treat the situation adequately: responsibly and seriously, but without panic.

If doctors assure you that you are overstaying your pregnancy and you need to bring it closer or, do not refuse. It is highly likely that the baby in your womb is not only uncomfortable, but also in danger.

What kind of pregnancy is called post-term?

How to know for sure if a pregnancy is overdue or not? After all, everything happens individually and you never know - what if today they just start? But while waiting, you can “lose” an important moment when the baby is uncomfortable in the female womb. So, ideally, pregnancy lasts 40 weeks. The obstetric period should be considered, it is determined from the first day of the last menstruation. And if you know, the exact day is 38 weeks. As a rule, in both cases there may be deviations of 14 days in one direction and the other, and this is quite normal. People say that a “correct” pregnancy takes 9 months, and in obstetrics this period of months is considered differently, there are 10 of them.

In principle, the normal gestational age is a loose concept. However, it has certain limits. In general, a normal pregnancy is one that lasts 37 to 42 weeks. If the baby in the womb of a woman is two weeks longer than expected, then we can talk about a delayed pregnancy.

This gap of a full five weeks may be the presence of many factors influencing the duration of pregnancy in each individual case. They say that the longer the female menstrual cycle, the greater the likelihood of normal gestation (40 weeks). With a short female cycle - from 36 weeks.

Also, the presence of some complications during pregnancy also affect its extension. Heredity also matters: if in your family the biorhythm of the intrauterine development of the baby is somewhat longer than usual, then it may be that you will give birth later.

We should not forget about the "psychological" overwearing. If you want to give birth to a spouse for a birthday, then you can realize your plan.

In addition to such overwearing, there are others - obstetric. Doctors distinguish the following of them:

prolonged - this is a normally proceeding gestation, which lasts two weeks longer than the accepted one. In this case, the baby is born functionally mature without any signs of overmaturity.
true - this kind is a threat to the child. At the same time, all the signs of the baby’s overwearing are present: the nails are long enough, the bones of the baby’s head are hard, the baby is very large, wrinkling and dryness of the baby’s skin, the absence of original lubrication during childbirth, a small amount of amniotic fluid, aging of the placenta.

You need to understand that in determining the overdose of pregnancy, not only the term is called an important determining factor, because you can miss with them. Before making a personal diagnosis, you need to undergo examinations for the state of the baby's activity, heartbeat, amniotic fluid, umbilical cord, placenta. And only on the basis of these results it is possible to make a final decision on whether and whether it is necessary to stimulate labor activity.

Here you can talk about a lot of things. After all, there are a lot of different reasons for overdose of pregnancy. Among them are:

the woman's age is more than 35 years;
obesity of a woman;
late ;
large fruit;
diseases of the intestines, stomach, liver;
irregular cycle, later or earlier onset of menstruation;
breech presentation;
violations of the activity of the ovaries, inflammation of the genital organs;
hormone treatment during pregnancy;
threats of termination of this pregnancy;
transferred before pregnancy and;
limited physical activity during pregnancy;
nervous strain, stress;
hormonal changes;
CNS disorders;
endocrine disorders such as diabetes.

All these important points can be the cause of overwearing.

It is believed that when overgestation is observed, a woman or baby is still “biologically” not ready for labor. In addition to the reasons that were listed above, they also note a deficiency of vitamins and an immature immune system of the baby. It is also necessary to remember about the psychological unpreparedness when a woman lives in a certain fear. For example, the fear of losing a baby could “turn off” the mechanisms necessary for childbirth, so they do not come at the right time. Then you need to completely relax and continue to live again, as if nothing had happened: to have sex with your spouse, to move a lot.

Mammary test for readiness for labor

You can check the readiness for childbirth at home. Lie down or sit in a comfortable position and try to relax as much as possible. Now begin to stimulate the nipples with your fingers - for 60 seconds and at this time keep your hand on your stomach below. Do this three times. If your body is physiologically ready for childbirth, then within the first 60 seconds a feeling will appear in the uterus. This can happen at a maximum of 3 minutes, then for 10 minutes you will feel several contractions of the uterus, namely three. In the first case, you are now ready for childbirth. But if it is already 40 weeks, and the child is hiding, this indicates that he is not ready yet - you need to wait.

It must be remembered that such a test should not be taken as the basis for making a final decision about overwearing. For this, there are medical examinations that will show whether it is time to give birth?

What is the dangerous prolongation of pregnancy?

Why is the "ideal" pregnancy 40 weeks? Because during this long time the fetus has already fully formed, grows and at the time of labor becomes ready and can live outside the womb of a woman. If the birth is premature, it is clear that the baby may not have time to fully develop and prepare, which can have its consequences. But what can happen during a reload? After all, the baby has already grown.

When the baby is in the womb of a woman longer than expected, changes and some processes begin to occur that negatively affect his health and well-being.

First of all, the baby experiences oxygen starvation. In addition, the umbilical cord and placenta are no longer able to perform their functions, all biochemical processes are disrupted and slowed down in them, and the needs of the baby during this period increase. At this time, the composition of the female amniotic fluid changes, they also become greenish or cloudy, and their number decreases, which increases the likelihood of entanglement with the umbilical cord. Living conditions in a woman's belly become uncomfortable and unbearable for a child. It develops as if it had already been born - this is noticeable by long nails, hair, such babies are born with open eyes.

Hardening of the bones of the baby is also of great danger, because when passing through natural paths, very serious injuries can occur to both the woman and the child. The fetus itself is already quite large, which also complicates labor. And about 10% of babies, on the contrary, begin to become dehydrated and lose weight. The protective mucus of the baby gradually disappears - the risk of infection of the baby's skin increases.

It is not uncommon for post-term babies to experience fluid retention in the lungs, which after birth makes it difficult for him to breathe.

There is also a risk of complications during labor. Water may break earlier, there is a high risk of bleeding.

All risks can increase if the expectant mother has a negative Rh factor.

Therefore, after 40 weeks, the pregnant woman is hospitalized in a hospital to conduct the necessary examinations and choose the most suitable method of delivery for her.

Delivery options

Pernenashivanie - this is not a diagnosis, but a pathology. Therefore, with him, the pregnant woman is sent to a special department of pathologies. There is a chance that childbirth will come on its own - this is at best. And if a thorough examination showed that the baby feels fine, and the pregnant woman is in perfect order, then the doctors are waiting for the start of vaginal delivery. If, nevertheless, childbirth does not occur, the uterus begins to prepare for the opening. When a woman's uterus is ready, they begin to stimulate childbirth.

All this time, the baby is closely monitored, tracking his heartbeat and physical activity. If an acute situation arises, delivery is started operatively. It should be noted that in case of overdose with some complications, the question of surgery may be raised initially.

We must not forget that after childbirth, the baby needs the “right” care, and the mother needs rehabilitation and observation.

And finally, about 95% of babies born between 41 and 43 weeks are absolutely strong and healthy. But this situation needs to be taken seriously. Let your labor activity be easy, and the child will be strong and healthy!

41 weeks: Overwearing or not?

What kind of pregnancy is called post-term

Why labor does not start on time

Medical tactics for post-pregnancy

Complications in post-term pregnancy

Keep calm and enjoy your pregnancy!

Nutrition and physical activity of expectant mothers

If your pregnancy has already reached the 41st week, and the long-awaited birth does not even think of starting, do not panic. This situation, according to our expert, occurs quite often - about every tenth woman.

Victoria POPOVA, Candidate of Medical Sciences, obstetrician-gynecologist at the multidisciplinary medical center "Clinic of Professor Pasman" talks about what causes differences in the duration of pregnancy in different women and what period is still considered optimal for childbirth.

What is the normal duration of pregnancy

The average duration of a full-term pregnancy is 280 days (40 weeks), more precisely 38-42 weeks from the 1st day of the last menstruation, or, on average, 266 days from the moment of ovulation with a 28-day menstrual cycle. But, given that each pregnancy is individual, it is not worth talking about prolonging the pregnancy at the 41st week. It should be taken as a waiting period for childbirth.

How to set the expected due date

There are several ways to help calculate the duration of pregnancy.

The obstetric method (by the date of the last menstruation) is the most common.

The main figure from which the countdown is carried out is the date of the beginning of the last menstruation. To do this, use the Naegele formula, 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 three full months are subtracted from the start date of the last menstruation and one week is also added.

Expert comment

This is how the gestational age is calculated, but not conception, because 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 menstruation has ended), and therefore the gestational age of the child will be approximately two to three weeks less.

When calculating the obstetric gestational age, they usually take into account only the average duration of the menstrual cycle with ovulation in the middle (on the fourteenth to fifteenth day). If you have irregular periods, cycle failures, it lasts more or less than twenty-eight days, you will have to take into account all these nuances. For example, if your cycle is longer, then add the required number of days to the proposed calculation, and if less, subtract.

Embryonic method (according to the 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 egg maturation.

The day of conception (known or suspected) corresponds to the full obstetric 2 weeks of pregnancy, i.e. on the first morning after successful intercourse, the gestation period 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 future mothers will be able to tell the doctor such accurate information.

Ultrasonography

The most effective method for determining the gestational age (the so-called period from the fertilization of an egg by a sperm to the birth of a child) is an ultrasound in the first trimester (measuring the diameter of the gestational vesicle up to 6 weeks, and then measuring the coccyx-parietal size of the fetus (KTR) up to 14 weeks).

Expert comment

Routine ultrasound in the 1st and 2nd trimesters of pregnancy has significantly reduced the frequency of previously recorded overmaturity. It is important to remember that the earlier an ultrasound is performed, the more accurately the gestational age can be determined. Measurement of the CTE of the embryo in the first trimester makes it possible to obtain the most accurate gestational age with an error of ± 3-5 days.

Determining the term according to KTP after 12 weeks becomes less accurate. And errors in determining the period according to ultrasound data in the III trimester are already increasing to 3-4 weeks!

Bimanual study on the first visit to the antenatal clinic in the first trimester, unfortunately, does not allow quite accurately determine the duration of pregnancy - the error is 2-3 weeks.

41 weeks: Overwearing or not?

With accuracy, at the 41st week, a woman will not be able to divide the overgrowth and a normal pregnancy on her own. Such an example, quite common in the literature, as a sharp decrease in the circumference of the abdomen due to a decrease in the amount of amniotic fluid is an extremely rare occurrence, but it is rather problematic to detect it even for the most pregnant woman. And therefore, the expectant mother is hardly able to adequately assess the situation - this is the direct task of obstetrician-gynecologists; all mothers should learn this so as not to expose themselves to unnecessary and often groundless worries. In any case, you should not worry until the full 41st week, with satisfactory health of the pregnant woman and the fetus, you can safely carry the pregnancy until it is completed.

” 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 for 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 safe delivery at 41-42 weeks.

Unfortunately, it is not uncommon for a pregnant woman to be admitted to a hospital at the 42nd week with an unprepared cervix, and the child also has all the signs of overgestation according to ultrasound. The only thing left is to resort to a caesarean section ...

So at the borderline (estimated 40 weeks), the doctor must assess the condition of the birth canal and decide whether to allow the expectant mother to stay at home until the full 41st week or 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 "overripeness", although both late births without signs of fetal overripeness and timely births with an overripe fetus occur.

Thus, “prematurity” is a calendar concept, and “overripeness” refers to the physical status of the fetus and newborn.

Expert comment

The diagnosis of overcarriage is confirmed by examination of the fetus and placenta. The presence of at least 2-3 of the following signs indicates the overripeness of the fetus:

weak expression of subcutaneous adipose tissue;

lack of caseous lubrication;

lifetime maceration of the skin (“bath hands and feet”);

dense bones of the skull, narrow sutures and fontanelles;

meconium-stained skin, umbilical cord in a newborn, fetal membranes and amniotic fluid;

long nails in a newborn;

lack of vellus hair;

decrease in turgor (elasticity) of the skin.

Why does labor activity not start on time?

And yet, why does the birth, expected according to the most accurate calculations, not begin? Unfortunately, the causes of pregnancy overshoot are still not clear. Overdose can be repeated with each subsequent pregnancy.

” In primiparous older than 30 years, overgestation is observed much more often.

Significant factors leading to a prolonged pregnancy are related to the field of neurology and endocrinology. Of certain importance are changes in the uterus that reduce its excitability and contractile activity: an insufficient number of receptors for oxytotic substances, a violation of the synthesis of contractile proteins in the myometrium.

” This is often associated with previous abortions and inflammatory diseases.

Expert comment

The role of autoimmune pathologies, endocrine-metabolic disorders, and even emotional tension is important in prolongation. Late maturation of the placenta, chronic placental insufficiency, as well as the preservation of placental immunological tolerance, which prevents immunological rejection of the fetus at the time of delivery, are important.

” - With severe overgestation, there are no killers against fetal cells in the blood of pregnant women. One of the reasons for the change in the immune status may be the genetically determined compatibility of the mother and fetus (family marriage), which contributes to a long retention of the fetus in the uterus.

Malformations of the central nervous system of the fetus can also be the reasons for the prolonged pregnancy of the fetus. They are accompanied by a decrease in the synthesis of corticosteroid hormones, on which the cascade release of prostaglandins and the development of labor activity depend. When pregnancy is overdue, fetal malformations are observed 10-15 times more often than in full-term pregnancy.

Medical tactics for post-pregnancy

Active management of pregnancy and childbirth during pregnancy allowed to reduce perinatal mortality by 2-3 times. What is an active tactic? At a 40-week gestation period, a pregnant woman is recommended to be examined: if the fetus is in a satisfactory condition, a delay from hospitalization is given until 41 weeks, during which the fetal motor activity is recorded, and fetometry of the fetus.

” With an uncomplicated course of pregnancy and the absence of significant risk factors, hospitalization earlier than 40.5-41 weeks is not advisable.

Overwearing poses a certain danger to the child, 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 immediately! On the contrary, all the efforts of doctors are aimed at natural delivery, because the re-carrying of 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 diseases of the mother and age over 30 years (if this is the first birth), then the issue can be resolved in favor of a planned cesarean.

Contrary to popular belief, a normal pregnancy can last from 38 to 42 weeks instead of 40 weeks. But what if your pregnancy has been going on for 42, 43 weeks, and the long-awaited baby is in no hurry to be born? Such cases are not so rare. According to WHO, they make up almost 10% of all pregnancies. Why is this happening?

Not all pregnancies lasting more than 40 weeks are post-term. Some are just the result of miscalculation. Determining the exact age of the embryo, and hence the date of the upcoming birth, is not so simple. There are true (biological) and imaginary (chronological) overbearing, in the latter case, the pregnancy is considered prolonged.

In pregnant women who have been on bed rest for a long time due to concomitant diseases, the fetus may not descend into the entrance to the small pelvis in a timely manner and not have an irritating effect on the receptor apparatus of the cervix.

Among maternal risk factors, chronic diseases of the genital area, hormonal disorders, hereditary factors, and a history of post-term pregnancies should be noted. Practice shows that the so-called macrosomia (fetal weight more than 4000 g) may also be the cause of overdose.

Caring for a post-term baby

The skin of over-ripe children is usually dry and flaky, more prone to irritation and diaper rash. Therefore, when changing diapers and diapers for a baby, you need to thoroughly wash it each time, blot it with a diaper and ventilate it, leaving the baby naked for a while. Be sure to use baby skin care products more often: cream or.

Postterm babies may have denser skull bones at birth, and their large fontanel may close faster than term babies. There is no pathology in this, and you should not be afraid of this.

If the aged placenta supplied the child with insufficient oxygen and nutrients, it is possible that he will weigh less than he should, and his growth will be normal. The baby must be properly fed, preferably, naturally, with mother's milk, more often applied to. If you follow these simple recommendations, then, as a rule, postterm babies begin to gain weight even faster than those born at term.

Otherwise, you need to care for a post-term baby in the same way as for a full-term baby. Moreover, we repeat, the vast majority of post-term children are born absolutely healthy.

During the bearing of a baby, women become very sensitive to any kind of changes in their condition, and this is what often helps to save the life of them and the unborn child.

After all, timely diagnosis of preterm labor and an urgent visit to the doctor, as a rule, allow you to save the pregnancy.

Premature birth is the birth of a baby between 28 and 37 weeks, whose weight varies between 1-2.5 kg. An earlier birth of a child (up to 28 weeks) is called childbirth only if after birth he lived for more than 7 days, otherwise this process is considered a miscarriage for a long time.

Causes of preterm birth

There are a number of reasons why preterm labor can occur. All of them can be divided into 3 main groups.

The first group includes reasons related to the health of the expectant mother.

Endocrine diseases - in connection with the presence of which the work of the thyroid gland, ovaries, pituitary gland and adrenal glands is impaired. As a result, an insufficient amount of hormones responsible for the normal development of the fetus and the continuation of pregnancy.

Isthmic-cervical insufficiency (ICN) is a pathology of the cervix, in which it cannot perform its holding function, shortens, softens and, under the pressure of the fetus, begins to open spontaneously (this can occur already in the middle of pregnancy).

The pregnancy is terminated when the fetal bladder begins to descend into the cervical canal. In order to diagnose CCI in time, you should register for pregnancy in a timely manner and undergo regular ultrasound, because it is with the help of these studies that you can determine the length of the cervix as accurately as possible and find out if there is a risk of preterm birth.

The main causes of ICI include an increased content of male sex hormones in the blood of a woman, uterine trauma during abortions, severe ruptures of the cervix during previous births, gross expansion of the cervical canal during diagnostic manipulations in the uterine cavity, etc.

Various kinds of infections - rubella, a number of venereal diseases, urogenital infections, etc. If a woman is healthy, then her uterine cavity is ideally sterile. However, due to the onset of any inflammatory process, the uterine wall becomes defective and the infection can easily penetrate into the amniotic fluid or even into the fetus itself.

In such a situation, the body begins to stimulate the production of a special substance - prostaglandin, which can cause premature birth. Therefore, the best option would be to undergo a series of studies for the presence of infectious diseases even before conception, because many of them can be asymptomatic (chlamydial, ureaplasma, mycoplasma infections, herpes simplex virus, etc.).

If the inflammatory process began during pregnancy, it must be urgently treated. In addition, modern medicine has a large number of tools that can significantly reduce the risk of miscarriage or infection of the fetus.

Features of the structure or development of the uterus - malformations of the uterus, infantilism (its underdevelopment), tumors of the uterus, etc.

Chronic diseases - diseases of the urinary tract, liver or kidney disease, hypertension, diabetes, etc.

The second group of reasons include a number of complications of pregnancy.

High sensitivity of the uterus - which can activate its contraction. However, with regular examinations, this feature is quite easy to diagnose, and therefore reduce the risk of preterm birth.

Severe gestosis - which can cause spontaneous abortion, or such a decision can be made by a medical council in order to save a woman's life;

Placenta previa - you may not know about the special location of your baby (too low, very close to the internal opening of the cervix or above it, etc.) until the II or even III trimester of pregnancy and the onset of bleeding. Therefore, once again we remind you of the need for regular examinations by a gynecologist.

Multiple pregnancy - due to which overstretching of the uterine wall can occur. Most often, in this situation, childbirth occurs about 3 weeks ahead of schedule.

Immunological conflicts - (by Rh factor, blood type, etc.).

The third group includes risk factors, the occurrence of which depends on the lifestyle of a woman.

Drug abuse - remember that pregnant women are not recommended to take drugs without consulting a doctor.

Strong weight gain - normal weight gain during pregnancy is about 12 kg;

non-vegetarian food (meat, dairy, flour).

Physically strenuous or standing work - Minimize physical activity at work, or better yet, get rid of it altogether. If, by the nature of your activity, you have to stand throughout the working day, try to take breaks more often and rest more.

Sexual relations in the last 2-3 months of pregnancy are not recommended, because due to the active contraction of the uterus during orgasm, the risk of premature birth increases;

Drinking alcohol and smoking.

Stress of experience and nervous strain are also fraught with premature birth, so set yourself up in a positive way, smile more and do not get upset over trifles.

Symptoms that indicate the approach of childbirth

In order for everything to end well and help to be provided on time, a pregnant woman needs to know about the main symptoms of preterm labor.

Let's list them:

pain and tightness in the lower back, as well as painful and regular uterine cramps;
nausea and indigestion;
change in vaginal discharge. They become more profuse and watery, and may be clear, rose-red, brownish or greenish;
the exit of a thick plug of mucus;
short and softened cervix. This symptom can be detected during an ultrasound scan, which will help the doctor to notice the shortening of the cervix in a timely manner and take the necessary measures to maintain the pregnancy.

The threat of early childbirth or their onset: how to distinguish?

Preterm labor can be threatening or already started. In the first case, it is still possible to prevent the baby from being born ahead of time, but if the cervix is already opening and the amniotic fluid has departed, it is simply impossible to prolong the pregnancy.

Signs of threatening preterm labor include intermittent pain in the lower abdomen and lower back, increased uterine tone, but with all this, the cervix still remains closed. In this situation, doctors can help keep the pregnancy as long as possible.

If you feel regular cramping pains in the lower abdomen with an increase in the tone of the uterus, and its neck is shortened and begins to open, and amniotic fluid comes out, then childbirth can no longer be delayed. How should a woman behave before the ambulance arrives?

If alarming symptoms are detected, a woman needs urgent hospitalization. Before that, she needs:

take an infusion of valerian or motherwort to soothe;
take drugs that relieve spasms and thereby “relax” the uterus, for example, no-shpu (2 tablets);
lie down;
tune in a positive mood and wait for the brigade.

Treatment of preterm birth at different times

Doctors try to prolong the onset of childbirth as much as possible, because each additional day spent by the child in the womb significantly increases his chances of life.

With the untimely start of contractions, drugs are prescribed that reduce the tone of the uterus. When this succeeds, doctors try to eliminate the immediate cause of premature birth.

So, if an infection is detected in a pregnant woman, she is prescribed antibacterial and sedative drugs.

When ICI is detected (up to 28 weeks), special “stretching” sutures are applied to the woman’s cervix, which prevent the fetal egg from falling out of the uterus.

With a gestational age of more than 28 weeks and the opening of the uterus, a supporting Golgi ring is inserted into the vagina, which is able to hold part of the fetus, thereby preventing pressure on the cervix.

In addition, the expectant mother is also prescribed a special hormone, the action of which is aimed at stimulating the speedy "ripening" of the baby's lungs, if he is still born ahead of schedule.

How are pregnant women with suspected preterm birth

If a premature opening of the cervix or rupture of the membranes is detected, the pregnant woman is hospitalized. In the hospital, a woman is provided with attentive care and health monitoring, and she is shown bed rest and good nutrition.

The circumference of the abdomen is measured daily for a pregnant woman, the position of the uterus above the womb is monitored, the body temperature, the frequency of her pulse and the fetal heart rate are determined every 4 hours, the amount and nature of the leaking waters are assessed. In addition, every 5 days, the contents of the cervical canal should be cultured, as well as smears from the vagina.

In the event of a rupture of the membranes and the threat of preterm labor (not their onset!) Doctors also prescribe special medications to delay the onset of labor. With a high probability of developing inflammatory complications, with CI, anemia, pyelonephritis and other chronic infectious diseases, antibiotics can be prescribed.

If labor has already begun, then doctors must constantly monitor the contraction of the uterus and monitor the condition of the fetus on the monitor. It should be noted that the duration of preterm labor, as a rule, is less than timely, which is explained by an increase in the rate of cervical dilatation and a small mass of the child, which does not require a high intensity of contractions.

However, it also happens that the contractile activity of the uterus is normal. In this case, during the management of childbirth, it is recommended to use expectant tactics with regular prevention of fetal hypoxia.

Preeclampsia, pathology manifests itself during pregnancy, while a short period of time can threaten the health of the child, find out the causes of preeclampsia and much more about this disease.

What types of cervicitis are the most severe and how to protect yourself from this disease, here you will find comprehensive information on this topic.

Ways to treat premenstrual syndrome that really help http://womensmed.ru/bolezni/menstrualnyj-cikl/predmenstrualnyj-sindrom.html find out how you can ease these days.

Possible consequences of such childbirth

Due to the fact that premature births are not the norm, they also have some consequences for both the woman in labor and her child. So, for example, in the case of "early" births, bleeding in the afterbirth period is often observed due to the retention of parts of the placenta, and inflammatory complications may also occur. For a baby, premature birth is dangerous due to the possibility of fetal hypoxia.

Features of premature babies

The body of a prematurely born child, as a rule, has not fully matured, which is why the baby has some features.

For example, the subcutaneous fatty tissue is not yet fully developed, the child has fluff on the body, the ear and nasal cartilages are soft, the length of the hair on the head is small, the umbilical ring is located lower than usual, the child's cry is very weak.

Also, in boys, the testicles may not yet be lowered into the scrotum, and the clitoris and labia minora of girls are not covered by large ones. The lungs of such children are still ready for full breathing, and the digestive tract is not able to fully assimilate those substances necessary for the baby that are contained in mother's milk.

The impact of preterm birth on the health of the baby

Preterm infants have very low resistance to infections. Due to the increased fragility of the blood vessels, hemorrhages can occur (most often in the cervical region or the ventricles of the brain). The most dangerous complications for such children are intracranial hemorrhage, respiratory distress syndrome and asphyxia.

If you are at risk of preterm labor, don't worry! And remember that the sooner you see a doctor, the higher the chance of preventing premature birth and giving birth to a beautiful baby at term.

Many women do not see a problem in the fact that their child may be born a week or two later than the expected date. A post-term pregnancy usually causes less fear and anxiety in expectant mothers than a premature one. However, it can also be a source of serious trouble for mom and baby.

As you know, physiological pregnancy lasts an average of 280 days (or), if you count from the first day of the last menstruation. During this time, a mature fetus develops, capable of extrauterine life. Pregnancy that lasts 10-14 days longer is called post-term. In this case, both the prolongation of physiological pregnancy and true overbearing are possible.

prolonged(or, if we literally translate this word from Latin, “extended”), a pregnancy is considered that lasts 10-14 days longer than the physiological one and ends with the birth of a functionally mature child without signs of overgestation and “aging” of the placenta.

True gestation characterized by the birth of a child with pronounced changes in the placenta and signs of overgestation: lack of original lubrication, dryness and wrinkling of the skin. In this case, the amount of amniotic fluid also decreases. With a significant overdose, an admixture of meconium (original feces) appears in the waters and their color becomes greenish or grayish.

According to various statistics, 2% of children are born post-term.

Reasons for overwearing

The reasons for overdue pregnancy are varied. Among them, endocrine disorders are of particular importance - changes in the functioning of the thyroid gland, diabetes mellitus, etc., as well as functional changes in the activity of the central nervous system. Overwear contributes to the changed ratio of hormones, in particular estrogen and progesterone. In women who have had abortions or pelvic inflammatory disease, the contractile activity of the uterus may decrease, which also often causes a prolonged pregnancy.

Researchers have noticed that in women who are postponing pregnancy, the nature of the menstrual function is usually changed. So, most often they have early and late onset of menstruation, unsteady, irregular menstruation.

Prolongation of pregnancy can also be associated with psycho-emotional shocks suffered by a woman. Overstrain associated with a variety of emotional stresses, as well as insufficient physical activity, are of importance.

Scientists also drew attention to the fact that pregnancy is often overdue in women suffering from diseases of the liver, stomach and intestines. These diseases can be predisposing factors, since liver damage disrupts the metabolism of estrogen (female sex hormones), which leads to a decrease in excitability, inertia of the uterus.

In pregnant women who have been on bed rest for a long time due to concomitant diseases, the fetal head may not descend into the entrance to the small pelvis in a timely manner and not have an irritating effect on the receptor apparatus of the cervix.

In addition to those listed, there are other risk factors for postponing pregnancy:

various ovarian dysfunctions;
habitual pregnancy;
present pregnancy and hormone treatment;
overdue previous pregnancy;
previous birth of a child weighing more than 4 kg;
previous pregnancies that ended in stillbirths;
the age of the primipara is more than 30 years;
the presence of concomitant pathology;
late preeclampsia;
pelvic presentation of the fetus;
sedentary, sedentary lifestyle of a woman before and during pregnancy.

What is dangerous post-term pregnancy

Prolongation of pregnancy is by no means good for the fetus. At birth, the fetus may remain normal in size, or may become large. The bones of the head of a post-term fetus become denser, the sutures and fontanelles decrease, and, as a result, the ability of the fetal head to change (reduce size due to the location of the skull bones on top of each other) during childbirth is reduced. The fetus's need for oxygen increases during pregnancy, and the placenta can no longer provide the required amount of oxygen and other vital substances. When it is worn out, hormone synthesis, metabolism, intensity of biochemical processes decrease in it, dystrophic changes occur in the villi, blood supply is disturbed, heart attacks occur - areas deprived of blood supply. The umbilical cord becomes flabby with significant overwearing. The amount of amniotic fluid decreases, and their composition changes. All this leads to a deterioration in the conditions of intrauterine life of the fetus.

In some cases, post-term pregnancy is complicated by early toxicosis and late preeclampsia, the threat of abortion in the early and later periods, intrauterine fetal hypoxia (lack of oxygen). Hypoxia, in turn, may be accompanied by relaxation of the rectal sphincter and the release of meconium (original feces). This sometimes causes pulmonary complications, brain damage, meconium aspiration, etc.

Childbirth during post-term pregnancy: possible problems

As for childbirth during a post-term pregnancy, they are also often complicated, which adversely affects the health of both the mother and the fetus. The most typical complications are:

premature or early discharge of amniotic fluid (a long anhydrous period can lead to infectious complications);
weakness of labor activity;
asphyxia (suffocation) in a child at birth; in addition, in such cases, the frequency of birth injuries increases (this is due to the fact that the period of exile is lengthened, and the sensitivity of the fetus to hypoxia and birth injuries is significantly reduced);
bleeding in the third stage of labor and in the early postpartum period (it may be associated with reduced contractile activity of the uterus, disruption of the process, ruptures of the soft tissues of the birth canal).

Diagnostics

The grounds for the diagnosis of post-term pregnancy are:

medical history data (date of last menstruation, first fetal movement, gestational age according to the first ultrasound examination):
data of an objective examination (density of the bones of the fetal head, a decrease in the circumference of the abdomen, deterioration in the cardiac activity of the fetus, a decrease in its motor activity);
data from additional research methods, which include:

Cardiotocography- study of fetal cardiac activity. This is the registration and recording on tape of the fetal heartbeat and contractile movements of the uterus using sensors that are fixed on the anterior abdominal wall of a pregnant woman. The average heart rate during full-term pregnancy and the normal state of the fetus is from 110 (120) to 160 beats per minute. A decrease or increase in the average heart rate indicates a deterioration in the condition of the fetus.
Ultrasound and Doppler. Of great importance in the diagnosis of the condition of the fetus is the determination of blood flow (Doppler) in the vessels of the umbilical cord, placenta, uterine arteries and vessels of the brain of the fetus.
Amnioscopy- study of amniotic fluid. At the end of pregnancy, cervical amnioscopy is used, while a special device is inserted into the cervix and allows you to see the water shining through. The green color of the waters indicates the intrauterine excretion of meconium - the original feces, which is a sign of fetal suffering. Amnioscopy can only be used when the cervix passes the device, that is, when it is soft and ready for childbirth.

Features of pregnancy and childbirth

A pregnant woman is hospitalized in the department of pathology of pregnant women of the maternity hospital. There, she is given an additional examination and the issue of further tactics of conducting pregnancy and childbirth is being decided.

Labor activity during a post-term pregnancy may occur spontaneously, but sometimes doctors have to resort to labor induction, taking into account the adverse effect of post-gestation on the fetus. Alarming signals in this case are a decrease in the motor activity of the fetus, a deterioration in its cardiac activity.

If the cervix of the pregnant woman is not ready for childbirth, then for several days it is prepared with the help of special hormone-containing gels, with the introduction of which the cervix softens and its canal expands. After preparing the cervix for childbirth, the pregnant woman is prescribed drugs that stimulate the contractile activity of the uterus.

A necessary condition for the conduct of childbirth during a post-term pregnancy is constant monitoring of the cardiac activity of the fetus. The obstetrician-gynecologist conducting labor listens to the fetal heartbeat every 15 minutes in the first stage of labor and after each attempt in the second period. Cardiac monitoring is indispensable in this case, in which a special sensor is attached to the abdomen of the woman in labor, which monitors the heart rate of the fetus. In cases of signs of fetal hypoxia, the necessary treatment is carried out and, if possible, they try to speed up the birth.

Childbirth in women with post-term pregnancy does not always end through the natural birth canal. If complications arise, one has to resort to operative delivery, that is, to a caesarean section. Such complications are the occurrence of acute intrauterine fetal hypoxia, weakness of labor, clinically narrow pelvis, etc. If during the period of exile, when the cervix has already fully opened, a discrepancy is found between the size of the fetal head (which can be large during a post-term pregnancy) and the mother's pelvis, that is, if during normal labor the head does not move along the birth canal, they speak of a clinically narrow pelvis. In this case, the size of the pelvis can be absolutely normal, but this pelvis will present difficulties or obstacles for the course of these births.

In some cases, doctors immediately decide to give birth by caesarean section. These include a combination of a pregnancy with a large fetus, a fetus, the age of the primiparous over 30 years, a scar on the uterus, etc.

In the postpartum period, mother and baby also need careful monitoring, especially if the birth was complicated.

We hope that the story of the difficulties that may accompany overpregnancy will warn expectant mothers against reckless refusals from hospitalization at a gestational age of more than . The implementation of all the recommendations of doctors, as well as the timely identification of women belonging to the "risk group" for recurrent pregnancy, will prevent possible complications in the mother and newborn.

Olga Ovchinnikova
obstetrician-gynecologist, medical clinic "Gazprommedservice"