Prolonged pregnancy: causes, consequences, tactics childbirth

Author of the article - an obstetrician Grigorieva Xenia S.

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In obstetrics perenashivanie called gestation of the child, which has exceeded 42 weeks. A birth in this case, called too late. The child at birth, there are signs of over-ripeness. According to statistics, perenashivanie happens to 14% of all pregnancies. The frequency of the birth of a large fetus increases to 30%, and this, in turn, leads to complications during childbirth.

Prolonged pregnancy is more common in women who gave birth for the first time or, conversely, in multiparous (more than 4 deliveries).

Gestational age is counted from the first day of the last menstrual period. If this day is unknown or irregular cycle in women, then the term is made by ultrasonic inspection data and gynecologist, which are more reliable criteria.

Delayed delivery is often accompanied the weakness of labor activity, Bleeding in the postpartum period, as well as an increasing number of cesarean section.

Causes

Perenashivanie causes of pregnancy include:

• menstrual dysfunction;
• endocrine disease (thyroid disease, obesity, diabetes);
• gestosis (edema, hypertension);
• infantilism (delay in sexual development);
• infectious and inflammatory diseases of the genital organs;
• metabolic disorders;
• fetal malformations.

The degree of prolonged pregnancy

In addition to the true perenashivanie pregnancy, there is a false (prolonged pregnancy). This is when, despite an increase in the length of gestation, the baby is developing normally and is born without any signs of over-ripeness. The placenta is formed in this case, too, in time and does not age. Therefore, prolonged pregnancy is considered normal. This is due to the peculiarities of the slow development of the fetus.

True prolonged pregnancy is characterized by the following symptoms after 42 weeks:

• pregnant weight reduction of more than 1 kg;
• stomach volume reduction of 5 cm or more, due to the decrease in the number amniotic fluid (Oligohydramnios);
• vaginal examination the doctor notes the increase in the density of bones of the skull of the fetus;
• fetal hypoxia - anoxia (determined by the physician on research data);
• instead of colostrum in a woman starts to separate the milk from the mammary glands;
• immature cervix at term (38-40 weeks).

Normally, the amount of fetal 1100-1200 ml water reaches the end of pregnancy (to week 40). Their volume is reduced to 150-200 ml with each successive week. Also, it is changing their composition. Water become turbid and whitish color due to the presence in them syrovidnoy lubrication. Also water may be fetal greenish or yellowish due to the presence of meconium (original cal) fetus.

There are 3 degrees perenashivanie fetus.

First degree:

• pregnancy period has been extended by 1 week
• the fetus is satisfactory, it marked an increase in traffic,
• amniotic fluid volume of 600-800 ml (according to ultrasound). when they observed the outpouring of whitish color instead of clear,
• the cervix is ​​ripe enough, and the presenting part of the fetus is not pressed tightly to the entrance to the pelvis - is determined by the physician using a vaginal examination,
• skin syrovidnoy quantity lubrication (whitish mass on the skin of the baby at birth), decreased newborn dryish. child's length can be 52-58 cm.

First degree perenashivanie be distinguished from prolonged pregnancy.

Second degree:

• perenashivanie for 2-3 weeks,
• a pregnant woman's cervix is ​​not mature. Presenting part of the fetus slightly pressed to the entrance to a small basin,
• abdominal circumference every day is reduced by 1-3 cm,
• notes and fetal hypoxia placental insufficiency - is determined by means of listening heartbeat, CTG and ultrasound,
• fetal heartbeat muffled, perturbations when it becomes either more often or less (determined according HIC). If, however, the child's movements, it does not change, then it suggests hypoxia,
• fetal movements become more scarce,
• on placentography (US) is determined by a thinning of the placenta. Also, according to US notes expressed hypamnion and decreased blood flow in the placenta,
• newborn are present in almost all the signs of over-ripeness (see. below) and hypoxia,
• muddy water, white color,
• genera are often accompanied by a long preliminary period (irregular contractions maloboleznennye in the onset of labor activities), or early prenatal outpouring of water, the weakness of labor, postpartum hemorrhage and pathologies placenta,
• often resort to caesarean section.

Third degree:

• perenashivanie 3-4 weeks (43-44 weeks)
• this degree is at, because in addition to severe hypoxia, the fetus may develop secondary malnutrition (lack of body weight)
• newborn skin has a greenish-yellow tint due to hypoxia and falling meconium in amniotic fluid,
• when the third degree has the risk of premature detachment of the placenta, often at the onset of labor,
• babies are born in this case, in critical condition (Apgar score less than 3 points)
• greatly reduced volume of amniotic fluid.

Signs overripe fruit (Bellentayna-Runge syndrome)

• skin and cord have a yellow-greenish tinge;
• skin wrinkling feet and hands - maceration (due to a long stay in the water);
• syrovidnoy little grease or she is absent;
• the skin becomes "old" look due to the depletion of subcutaneous fat and the formation of folds on the body;
• child large size or, conversely, with malnutrition (rarely);
• on hands long nails;
• skull bones dense, fontanels narrowed.

A child is considered post-term, if there are more than two of the above symptoms.

The number of days post-term is not the most reliable sign of pathology. Much depends on the characteristics of the mother's body and fetus, as well as the development of the placenta and the state. Sometimes it happens that perenashivanie 1-2 weeks accompanied by symptoms of the third degree. Conversely, when the extension of the delivery to 2-3 weeks, the fetus may not be showing signs of over-ripeness.

Determining the exact time of birth date

There are several ways to count the duration of pregnancy and birth date:

1. Date of the first day of the last menstrual period (maternity period). Date of birth can be calculated, if the first day of the last menstrual period add 7 days and subtract 3 months.
2. By date of conception (if a woman knows exactly what day got pregnant when I was unprotected sexual intercourse).
3. According to ovulation.
4. On the first prenatal visit for registration. Doctor using a vaginal examination determines the size of the uterus, which speak of gestation. Held in the first trimester.
5. On the first baby move.
6. According to US (the most reliable method, especially before 12 weeks of pregnancy).

The diagnosis of post-term pregnancy is put on the basis of symptoms, date of birth and signs of over-ripeness of the newborn and placenta.

Based on clinical data it can be noted that at 41 weeks juice symptoms over-maturity of the fetus revealed in 35% of cases, in 42 weeks - 75%, in 43 or more - 96%.

Amnioscopy an additional diagnostic method which allows to determine perenashivanie. With this study can detect changes fetal water (coloring, quantity, and presence of meconium syrovidnoy lubrication) - with the consent of the woman in the cervical canal is introduced amnioscope by which a doctor assesses water condition. Do not confuse this procedure with amniocentesis.

To detect fetal hypoxia using ultrasound, CTG, or listening to the fetal heart obstetric stethoscope.

differential diagnosis

True prolonged pregnancy must be differentiated from false. If the gestation period is increased, and the child is born without signs perenoshennosti, such a pregnancy - a prolonged (false post-term). If the newborn has signs of over-ripeness, the pregnancy is called a true post-term.

conducting delayed deliveries Tactics

When gestational age of 40 weeks or more obstetricians offer a woman hospitalized in a hospital in order to examine the condition of the child and decide on the method of delivery. labor management strategy depends on the maturity of the cervix, the status of the fetus, and other comorbidities.

Childbirth naturally take place in the case of cervical maturity. To do this, carry out labor induction. If the cervix is ​​immature, then apply the gel to the prostaglandins or laminaria, which accelerate its maturation.

Rodovozbuzhdenie performed using amniotomy (opening membranes). If after this method over 4 hours generic activity is absent, the method of using a medical induction of labor (using drugs: oxytocin and prostaglandins).

In the above methods is carried inefficiency caesarean section.

Indications for cesarean section at term pregnancy:

• after labor induction methods cervix is ​​immature;
• fetal breech;
• nulliparous age (over 35 years);
• IVF stillbirth, miscarriage history;
• the scar on the uterus;
• narrow pelvis:
• grave condition of the fetus.

possible complications

What can cause prolonged pregnancy:

• fetal hypoxia - lack of oxygen (the most frequent complication). This happens due to the aging of the placenta, it ceases to cope with their basic functions (delivery of oxygen from the mother to the fetus).
• meconium aspiration fetus. Due to hypoxia in the fetus is relaxation of the anal sphincter and into the amniotic fluid enters meconium. There is therefore a risk of ingestion of fruit and enters the lungs at birth.
• large fruit (30-35% of cases). Newborns are born with a weight of more than 4-4.5 kg.
• entanglement umbilical cord, which can cause asphyxia and baby in childbirth.
• birth injuries. With perenashivanie pregnancy the fetus occurs ossification of skull bones, and this, in turn, increases the risk of injury in childbirth (a woman breaks the fetus generic tumor, cephalohematoma).
• uterine inertia.
• Pathology of the placenta.
• postpartum hemorrhage.
• infection (for both mother and fetus). With perenashivanie pregnancy the amniotic fluid and the placenta loses its protective function.

Forecast

If a woman has gestational age reaches 40-41 per week, you need to see an obstetrician-gynecologist, to pass examinations to monitor fetal status and to be hospitalized in order to expedite delivery. With timely delivery, the risk is minimal complications.

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Some studies in pregnancy

• Smears in pregnancy
• Analyzes during pregnancy trimesters
• Ultrasound in pregnancy
• Urinalysis in pregnancy
• coagulation
• Installing pessary
• glucose tolerance test
• Homocysteine ​​in pregnancy
• Anesthesia during childbirth
• Fetal CTG (cardiotocography)
• cordocentesis
• Epidurals in labor