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Uma was very excited about the coming baby. It was her first pregnancy after all! She was eating healthy, exercising regularly, and was having a trouble free pregnancy. All was well. Then the due date came and went. But there was no sign of the baby. Close to 42 weeks and she still hadn't delivered. Now what?
Uma was having, what is technically called, post term pregnancy where a pregnancy lasts more than 42 weeks, that is, 294 days since the first day of the last menstrual period. Generally, women deliver between 37 and 42 weeks of pregnancy. But statistics show that only 5 percent of babies are delivered on the exact due date. And the reported post term pregnancy is anywhere between 3 to 12 percent.
Although you don't have to be too alarmed if you are past your delivery date, prolonged pregnancy does have certain risks for the baby and the mother.
Post term pregnancy risk for the mother
Post term pregnancy risk for the baby
The baby might be born absolutely healthy in most cases, but in some cases
Causes of post term pregnancy
Medical fraternity is not very sure why post term pregnancies occur. In most cases, it is attributed to miscalculation in the due date. Normally, the last menstrual period (LMP) is used to calculate the estimated due date (EDD). Inaccuracies occur in women who
However, ultrasonographic dating done early in pregnancy can improve the reliability of the EDD (estimated due date).
Another cause of post term pregnancy could be your genes. A Danish study published in the American Journal of Obstetrics & Gynecology suggested that 'genetic factors account for 23% to 30% of the liability to prolonged gestation' and it is the maternal but not paternal genetic factors that influenced the rate of post term pregnancies.
Research also indicates obesity to be one of the causes of post term pregnancy that progress beyond 41 or 42 weeks of gestation. 'Obese women have 69% higher adjusted odds of reaching 42 weeks' gestation, compared with women of normal pre-pregnancy BMI,' says Dr. Stotland from the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco.
Management of post term pregnancy
Once you have crossed the 39 week mark, your doctor will monitor you closely and recommend specific management for post-term pregnancy based on your overall health and medical history, your tolerance for specific medications or therapies, and your opinion, expectations or preferences.
Maternal and foetal tests will be performed to monitor for signs of problems. Some of these tests are:
If a foetal problem shows up in testing or it is more than two weeks past your due date (equal to or less than 42 weeks), it is time to deliver.
Your doctor will 'induce labour' if it doesn't start on its own. One of the minimally invasive interventions is inducing labour by a technique called 'sweeping the foetal membrane'. Stripping or sweeping of the membranes means digital separation of the membranes from the wall of the cervix and lower uterine segment. Your doctor will gently separate the bag of water from the side of the uterus near the cervix. This procedure will release prostaglandins (hormones) from the cervix and prepare the uterus to contract. Once the contractions start, the cervix will open (dilate).
Using a Foley catheter or using IV infusion of oxytocin are other methods of ripening the cervix and inducing labour.
Various studies have shown that unprotected sexual intercourse and acupuncture can also induce labour. Unprotected coitus is very similar that of stripping of the membranes in its action as it causes uterine contractions through the action of prostaglandins in semen and potential release of endogenous prostaglandins from the cervix. However, the studies show conflicting data, so its efficacy cannot be assessed. So is the case with acupuncture. Since there is lack of large studies regarding induction of labour with acupuncture, this too requires further trials to confirm its efficacy.
Management of post term pregnancy is a complex issue. And the decision to induce labor is a difficult one and has its own set of risks. You and your doctor need to work together to come up with a solution that works best for you.
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