In obstetrics a delayed called term pregnancy that has exceeded 42 weeks. And giving birth in this case are called belated. The child at birth, there are signs of over-ripeness. According to statistics, perenashivanie happens to 14% of all pregnancies. The rate of birth of a large fetus increases to 30%, and this, in turn, leads to complications in childbirth.
Post-term pregnancy is more common in women who gave birth for the first time or, conversely, in multi-expensive (more than 4 births).
Pregnancy is counted from the first day of the last menstrual period. If this day is unknown or the cycle of a woman is irregular, the term is put on the basis of ultrasound and gynecologist examination, which are more reliable criteria.
Delayed delivery is often accompanied by weakness of labor, bleeding in the postpartum period, and the number of cesarean section operations increases.
Reasons
Reasons perenashivanie pregnancy can serve:
• violation of menstrual function;
* endocrine diseases (thyroid disease, obesity, diabetes);
* gestosis (edema, hypertension);
* infantilism (delay in sexual development);
* infectious and inflammatory diseases of the genitals;
• metabolic disorder;
• malformations of the fetus.
Degrees of post-term pregnancy
In addition to the true perenashivanie pregnancy, there is about (prolonged pregnancy). This is when, despite the increase in gestational age, the baby develops normally and is born with no signs of over-ripeness. Placenta in this case is shaped, too, in term and not is aging. Therefore, prolonged pregnancy is considered the norm. This is due to the characteristics of the slow development of the fetus.
True post-term pregnancy is characterized by the following signs after 42 weeks:
* reducing the weight of a pregnant woman by more than 1 kg;
* decrease in abdominal volume by 5 cm or more, due to a decrease in the amount of amniotic fluid (lack of water);
* in vaginal examination, the doctor notes an increase in the density of the fetal skull bones;
* fetal hypoxia-oxygen starvation (determined by the doctor according to research);
• instead of colostrum in women starts to separate milk from the mammary glands;
* immature cervix in full-term pregnancy (38-40 weeks).
Normally, the amount of fetal water reaches 1100-1200 ml by the end of pregnancy (40 weeks). Their volume decreases by 150-200 ml with each subsequent week. Their composition is also changing. The waters acquire a turbid and whitish color due to the presence of a cheese-like lubricant in them. Also, the fruit waters may be greenish or yellowish due to the presence of meconium (original feces) of the fruit.
There are 3 degrees perenashivanie fetus.
First-degree:
* pregnancy extended by 1 week,
* the condition of the fetus is satisfactory, its increased movements are noted,
* the volume of amniotic fluid is 600-800 ml (according to ultrasound). at their outpouring whitish color instead of transparent is noted,
* the cervix is not Mature enough, and the preposition of the fetus is not pressed tightly to the entrance to the pelvis – this is determined by the doctor with the help of vaginal examination,
* the skin of the newborn is dryish, the amount of cheese-like lubricant is reduced (whitish mass on the skin of the child during childbirth). The length of the child can be 52-58 cm.
The first degree of perenashivaniya must be distinguished from prolonged pregnancy.
Second degree:
* resetting for 2-3 weeks,
* a pregnant woman's cervix is not Mature enough. The protruding part of the fetus is weakly pressed to the entrance to the pelvis,
* abdominal circumference decreases by 1-3 cm every day,
* there is fetal hypoxia and placental insufficiency-determined by listening to the heartbeat, CTG and ultrasound,
* fetal heartbeat is muffled, when stirring it becomes either more often or less frequently (determined by CTG data). If the movements of the child, it does not change, it indicates hypoxia,
* fetal movements become rarer,
* placentography (ultrasound) determines the thinning of the placenta. Also, according to ultrasound, there is a pronounced lack of water and a decrease in blood flow in the placenta,
* the newborn has virtually all signs of over-maturity (see below) and hypoxia,
* water turbid, white color,
* childbirth is often accompanied by a long prelim period (irregular, low-pain contractions at the very beginning of labor), early or prenatal outpouring of water, weakness of labor, postpartum bleeding and pathologies of the placenta separation,
• most often resorted to cesarean section.
Third degree:
* rescheduling for 3-4 weeks (43-44 weeks),
• this degree is extreme, as in addition to severe hypoxia, the fetus may develop secondary hypotrophy (lack of body weight),
* the skin of the newborn has a greenish-yellow tint due to hypoxia and meconium ingress into the amniotic fluid,
* in the third degree, there is a risk of premature placental abruption, most often at the beginning of labor,
* newborns in this case are born in an extremely serious condition (on the Apgar scale less than 3 points),
* the volume of amniotic fluid is greatly reduced.
Signs of over-ripeness of the fruit (syndrome Ballantyne-Runge)
* the skin and umbilical cord have a yellow-greenish tint;
* wrinkling of the skin of the feet and palms-maceration (due to prolonged stay in the waters);
* little or no cheese grease;
* the skin becomes "senile" appearance due to the depletion of subcutaneous fat and the formation of folds on the body;
* a child of large size or, conversely, with hypotrophy (rarely);
* on the hands of long fingernails;
• dense bones of the skull, the fontanelles closed.
A child is considered to have been born if there are more than two of the above symptoms.
The number of days transferred is not the most reliable sign of pathologies. Much depends on the characteristics of the mother and fetus, as well as on the development and condition of the placenta. Sometimes happens so, that perenashivanie on 1-2 weeks is accompanied by of the hallmarks of the third extent. And, conversely, when extending the delivery period for 2-3 weeks, the fetus may not show signs of overripe.
Determination of the exact date of delivery
There are several ways to calculate the period of pregnancy and the date of birth:
1. By the date of the first day of the last menstruation (obstetric period). Date of birth can be calculated, if the first day of your last period add 7 days and subtract 3 months.
2. On date fertilization (in case if woman accurately knows, in what day came pregnancy, when was unprotected gender an act of).
3. Ovulation.
4. On the first visit to the women's clinic for registration. Doctor using a vaginal examination determines the size of the uterus, which speak of the duration of pregnancy. It is carried out in the first trimester.
5. At the first movement of the child.
6. According to ultrasound (the most reliable method, especially up to 12 weeks of pregnancy).
The diagnosis of post-term pregnancy is based on the symptoms, delivery time and signs of overripe newborn and placenta.
On the basis of clinical data, it can be noted that in the juice of 41 weeks, signs of overripe fruit are detected in 35% of cases, in 42 weeks - 75%, in 43 and more - 96%.
Amnioscopy is an additional diagnostic method that allows you to determine the overexposure. With this study, you can detect changes in fetal water (staining, quantity, presence of meconium and cheese grease) - with the consent of the woman in the cervical canal amnioscope is introduced with which the doctor assesses the state of the waters. This procedure should not be confused with amniocentesis.
To detect fetal hypoxia, ultrasound, CTG or listening to the fetal heartbeat with an obstetric stethoscope are used.
Differential diagnosis
True post-term pregnancy should be differentiated from false pregnancy. If the gestation period is increased, and the child is born without signs of postponement, then such a pregnancy is prolonged (false postponement). If the newborn has signs of overripe, the pregnancy is called true transferred.
The tactics of delayed deliveries
When the gestation period is 40 weeks or more, obstetricians and gynecologists offer a woman to be hospitalized in the hospital to examine the condition of the child and decide on the method of delivery. Tactics of labor depends on the maturity of the cervix, the state of the fetus and other comorbidities.
Childbirth naturally takes place in the case of maturity of the cervix. To do this, perform labor excitation. If the cervix is immature, the gel is used with prostaglandins or kelp, which accelerate its maturation.
Labor excitation is carried out by amniotomy (opening of the fetal bladder). If after this method within 4 hours labor activity is absent, then use the drug method of stimulation of labor (with the help of drugs: oxytocin and prostaglandins).
If the above methods are ineffective, a caesarean section is performed.
Indications for cesarean section in post-pregnancy:
• following the methods of labor induction the cervix remains unripe;
• breech presentation of the fetus;
* age of primiparous (over 35 years);
* IVF, stillbirth, history of miscarriages;
• uterine scar;
• pelvis:
• severe condition of the fetus.
Possible complication
What can lead to a postponed pregnancy:
* fetal hypoxia-lack of oxygen (the most common complication). This is due to aging of the placenta, it ceases to cope with its basic functions (delivery of oxygen from the mother to the fetus).
* aspiration of the fetus with meconium. Due to hypoxia, the fetus relaxes the anal sphincter and meconium enters the amniotic fluid. Therefore, there is a risk of its ingestion by the fetus and getting into the lungs during childbirth.
* large fruit (30-35% of cases). Newborns are born weighing more than 4-4. 5 kg.
* umbilical cord entanglement, which can cause asphyxia in childbirth