You. Your Pregnancy. Your Baby.

Postterm pregnancy & placental insufficiency

If your pregnancy continues two or more weeks past your estimated due date, it is considered postterm.

Your doctor will become concerned about the health of your baby as the pregnancy continues past week forty two. Unfortunately it is difficult for doctors to determine the exact date of conception, since the date of ovulation is only approximate.

Like their adult counterparts, all babies are different, so the length of development is varies. Labor is triggered by hormonesA complex chemical substance created in a part or organ of the body. When released it initiates or regulates activity in an organ or group of cells in another part of the body.
Hormones secreted by endocrine glands are transported through the bloodstream to their target organ. The amount of hormone secreted is regulated either by other hormones, by neurotransmitters, or simply when an excess of the organ's activity indicates a need to reduce the amount of the hormone produced.
Other hormones are produced locally by the organs themselves and are common in the digestive tract.
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produced by your baby as it matures, and the date of delivery is not exact.

Incidence of postterm pregnancy

The estimated due dateSometimes abbreviated to EDD, or referred to as the Estimated Date of Delivery. The EDD is calculated as 280 days after the first day of the last menstrual period.
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is a statistical average. In reality, only five percent (1 in 20) babies are born on their due dates. Forty percent (2 in 5) babies are born during week forty one or later. About ten to twenty five percent (2 - 5 in 20) of them are born after week forty one. Twelve percent (3 in 25) hold out till week forty three or later, with the final three percent (1 in 30) hanging in till week forty four.

As the pregnancy continues the baby often continues to grow. About twenty percent (1 in 5) babies will grow to nine or more pounds at delivery, with an increased incidence of cesarean section because they are unable to pass through the birth canalThe passage through which the baby passes during delivery from the inlet of the true pelvis to the vaginal orifice.
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. Three percent (1 in 33) babies will continue to grow until they weigh ten pounds or more at delivery!

Risk factors for postterm pregnancy

The cause of postterm pregnancy is still unknown but while there are many theories, researchers have discovered that if you have a history of postterm pregnancy, there is a fifty percent chance of recurrence.

Placental insufficiency

By the end of your pregnancy, the placenta has grown to the size of a dinner plate, one inch (2.5cm) thick. Looking like a piece of raw liver, the side that is attached to the uterus is divided into wedges called cotyledons.

There is a misconception that the placenta ages during pregnancy. In fact the organ is tremendously resilient, and has the ability to repair damage resulting from insufficient oxygen, or ischemia. As the pregnancy progresses, the different components of the placenta simply change their appearance.

By week thirty six, calcium deposits begin to appear on the surface of the villi, limiting the exchange of nutrients and waste between the mother and baby. But this is balanced until term by the proximity of the fetal blood vessels and the villi themselves. After week forty two, the placenta will slowly start to lose its efficiency, and no longer be able to supply the baby with nutrients and support. Your doctor will monitor the health of your baby as it continues past term, and if there are signs of fetal distressA condition, usually discovered in labor, in which the fetal heartbeat follows an abnormal pattern. The fetal heartbeat is recorded using electronic fetal monitoring.
The acid balance of the fetal blood is measured, and labor is allowed to continue if it falls within prescribed ranges, and the abnormal heartbeat does not recur or persist.
If nescessary, attempts will be made to stabilize the fetus by administering oxygen to the mother, increasing her fluid intake or prescribing an agent to help the uterus relax. In some cases a cesarean section may be required.
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, labor will be induced.

Placental insufficiency and your baby

Most babies remain healthy in the uterus beyond week forty two. Placental insufficiency affects only twenty percent (1 in 5) postterm babies, resulting in signs of fetal distressA condition, usually discovered in labor, in which the fetal heartbeat follows an abnormal pattern. The fetal heartbeat is recorded using electronic fetal monitoring.
The acid balance of the fetal blood is measured, and labor is allowed to continue if it falls within prescribed ranges, and the abnormal heartbeat does not recur or persist.
If nescessary, attempts will be made to stabilize the fetus by administering oxygen to the mother, increasing her fluid intake or prescribing an agent to help the uterus relax. In some cases a cesarean section may be required.
Visit our comprehensive glossary for more pregnancy terms and definitions.
, reduced amniotic fluidThe liquid, which is produced by both the fetal membranes and the fetus that surrounds the baby during pregnancy. The liter of fluid at term serves to protect the fetus during pregnancy and also provide active chemical exchange.
The amniotic fluid consists of maternal and fetal plasma in varying concentrations. The pH of the fluid is almost neutral and clear, although lipids and desquamated fetal cells can make it cloudy.
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, weight loss and meconiumWaste material that collects in the intestinal tract of the unborn fetus. It is thick and sticky in consistency and varys in color from dark green to black.
It is formed from a variety of substances from amniotic fluid to secretions in the intestinal tracts. The presence of meconium in the amniotic fluid is usually a sign of fetal distress.
After birth the color and consistency of the stool changes with the ingestion of breast milk or formula.
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aspiration.

MeconiumWaste material that collects in the intestinal tract of the unborn fetus. It is thick and sticky in consistency and varys in color from dark green to black.
It is formed from a variety of substances from amniotic fluid to secretions in the intestinal tracts. The presence of meconium in the amniotic fluid is usually a sign of fetal distress.
After birth the color and consistency of the stool changes with the ingestion of breast milk or formula.
Visit our comprehensive glossary for more pregnancy terms and definitions.
aspiration occurs in fifteen percent (1 in 6) pregnancies by week forty. It is a sign of fetal distressA condition, usually discovered in labor, in which the fetal heartbeat follows an abnormal pattern. The fetal heartbeat is recorded using electronic fetal monitoring.
The acid balance of the fetal blood is measured, and labor is allowed to continue if it falls within prescribed ranges, and the abnormal heartbeat does not recur or persist.
If nescessary, attempts will be made to stabilize the fetus by administering oxygen to the mother, increasing her fluid intake or prescribing an agent to help the uterus relax. In some cases a cesarean section may be required.
Visit our comprehensive glossary for more pregnancy terms and definitions.
, especially if it is thick and there is little amniotic fluidThe liquid, which is produced by both the fetal membranes and the fetus that surrounds the baby during pregnancy. The liter of fluid at term serves to protect the fetus during pregnancy and also provide active chemical exchange.
The amniotic fluid consists of maternal and fetal plasma in varying concentrations. The pH of the fluid is almost neutral and clear, although lipids and desquamated fetal cells can make it cloudy.
Visit our comprehensive glossary for more pregnancy terms and definitions.
. Your doctor will use internal fetal monitoring to determine whether the baby is in distress.

Postmature babies lose all their body fat, leaving their skin red and wrinkled. By week forty three the risk of stillbirth doubles, and they are five times safer outside the uterus. The following week the risk of stillbirth has tripled, and the risk of remaining in the uterus is seven times greater than delivery. Your doctor will seriously consider the possibility of inducing the baby by this stage of the pregnancy.

Managing postterm pregnancy

If this is your first pregnancy and you baby has not engagedThe term used to describe the final portion of pregnancy during which the baby's head (or other presenting part) has settled into the pelvic cavity.
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in the two weeks following your due date, your doctor will become concerned about cephalopelvic disporportionA condition in which the size of the baby's head is markedly larger than the size of the maternal birth canal. In some instances it is possible for the baby to be born vaginally although the most usual and safest course of action is delivery by cesarean section.
Visit our comprehensive glossary for more pregnancy terms and definitions.
. To make sure that the baby's head will pass safely through the birth canalThe passage through which the baby passes during delivery from the inlet of the true pelvis to the vaginal orifice.
Visit our comprehensive glossary for more pregnancy terms and definitions.
, your doctor will ask you to lie on your back. This will allow the doctor to feel the head of the baby resting at the brim of the pelvis. You will then be asked to prop yourself on your elbows. If your baby's head slips into the pelvis there is no risk of cephalopelvic disporportionA condition in which the size of the baby's head is markedly larger than the size of the maternal birth canal. In some instances it is possible for the baby to be born vaginally although the most usual and safest course of action is delivery by cesarean section.
Visit our comprehensive glossary for more pregnancy terms and definitions.
.

For this reason many pregnancies are induced after week forty two. As your pregnancy continues past term, your doctor will use the nonstress test, contraction stress test, nipple stimulation test and biophysical profile to monitor the baby to ensure that it is healthy and active. Ultrasound may also be used to make sure that your baby is healthy and active. But if testing shows that the baby is healthy and vigorous (no signs of post maturity) then your doctor may wait until labor begins naturally. A family history of longer than average gestation will reassure your doctor that your pregnancy is safe, and can continue while being closely monitored.


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Labor & Delivery