Mature pregnancy

A pregnant pregnancy is an increase in the duration of pregnancy relative to the time taken for a normal period of two or more weeks. The childbirth at the end of a delayed pregnancy is called belated. The transferred pregnancy is registered in 10% of pregnant women and is not always associated with pathology.

Establish with absolute certainty the true period of pregnancy is not always possible, so a significant number of episodes of repetition have a favorable outcome. However, if the "age" of the fetus is determined precisely, too long stay in the womb can provoke serious consequences.

Why are pregnant? The causes of a delayed pregnancy can not be reliably established, they are not sufficiently studied, and sometimes too complex. There is a close relationship between the nature of the course of pregnancy (namely, its duration) in women in one family, which suggests a certain significance of heredity in a pregnant pregnancy.

Not only a single pregnancy can be transplanted, quite often a pregnancy is accompanied by several pregnancies.

The second pregnant pregnancy can no longer be considered an episodic and harmless event. It is believed that this repetition of the situation is associated with structural and functional disorders in the uterus against a background of pronounced inflammatory process or due to mechanical injuries of the endometrium (abortions, diagnostic scraping and similar manipulations).

A pregnant pregnancy can end with the usual birth, but often the generic activity has to be induced medically. If the contractile functions of the uterine musculature are violated, it becomes unable to independently eject the fetus, so it needs stimulation from the outside.

The pregnant pregnancy itself affects slightly the pregnant woman, with the exception of childbirth, which is more often complicated. Much more important is how the fetus reacts to it. Intrauterine development of the fetus entirely depends on the placenta, which provides the developing organism with oxygen and necessary substances for nutrition and tissue formation. Placenta as a temporary structure is able to fully perform the necessary functions only for a certain period of time, equal to the term of "normal" pregnancy. Then its resources are depleted, it "grows old" and ceases to support the vital functions of the fetus at the required level. Since the fetus continues to develop when it continues to develop, it grows larger, and its adaptive abilities decrease sharply.

Sometimes the "aging" of the placenta is diagnosed much earlier than the term of labor, at the 27th - 32nd week of gestation. In such a situation, the pathology does not correlate with perenashivaniem, as indicates a fetoplacental dysfunction.

It should be noted that perenashivanie refers to the calendar concept, it is noted after the 42nd week of pregnancy.

A pregnant pregnancy can proceed according to the physiological norm and result in the birth of a perfectly healthy child. In this situation, they talk about prolonged pregnancy. It is believed that sometimes the fetus needs a little more time to develop, so the pregnancy lasts longer. Prolongation of pregnancy is correlated with the physiological state and is not considered pathological. As a rule, pregnancy is not prolonged for longer than two weeks.

When a fully matured fetus continues to be in the uterine cavity after a certain period of time, pregnancy is classified as "overripe". In this case, the fetus has pronounced signs of endurance, and childbirth either does not occur on its own, or proceed with complications.

To differentiate the prolonged pregnancy from an overripe, it is necessary to determine the instrumental state of the fetus and compare it with the period of pregnancy. Cardiotocography and ultrasound scanning are performed.

The management of a delayed pregnancy does not imply a prolonged medical correction, since in the negative state of the fetus, its continued stay in unfavorable conditions is undesirable. Treatment of a delayed pregnancy, in fact, is reduced to its completion by a medication or by an operative route.

Complications of a delayed pregnancy can be conditionally divided into associated with the violation of the generic process and the consequences for the fetus. The extensive arsenal of modern diagnostic techniques in most situations of over-dosing allows eliminating potential threats for both the fetus and the pregnant.

Causes of a pregnant pregnancy

Why are pregnant? It is believed that the true pererashivanie provokes not the only reason, but a combination of several factors, their full list has not yet been established.

It is necessary to dwell in detail on one of the most common and innocuous causes of a pregnant pregnancy - an incorrect calculation of the gestational age. First of all, inaccuracies in the calculations can occur due to menstrual dysfunction: if the menstruation initially did not differ in regularity, the most probable date for ovulation is more difficult to calculate than in the normal cycle.

Also, errors in the calculations occur with late primary appearance of a pregnant woman, a delay in normal fetal growth, and the presence of myomatous nodes in the uterine cavity. Whatever the calculated duration of pregnancy, the main criterion for its proper development is the symmetry of the increase in the duration and development of the fetus.

If during the examination of the signs of "overripeness" the fetus is not found, it is stated that there is a false overstretch, that is, a prolonged pregnancy.

Biological, true, perenashivanie has several reasons, the most important of them is the dysfunction of the brain, responsible for the correct regulation of the course of pregnancy. Also important role in increasing the terms of bearing belongs to:

- Hormonal dysfunction. The key to successful development and termination of pregnancy is determined by several important hormones: progesterone, chorionic gonadotropin, estrogens, prostaglandins and others. In the case of their incorrect secretion, pregnancy also develops incorrectly.

- Pathologies of the fetus: Down's syndrome , complex malformations of the brain, kidneys.

- Violations of the functioning of the placenta, when it is not able to properly provide the developing organism with the necessary oxygen and nutrients.

- Pathologies of the mother: psychological traumas, transmitted infections (especially viral), unhealthy heredity, extragenital pathologies, numerous abortions.

The second pregnant pregnancy is never considered an accident and requires a detailed examination.

Symptoms and signs of a pregnant pregnancy

Nature has given pregnancy a certain period for development, so that the compensatory mechanisms of the body could help the pregnant woman adapt to "life together", and the fetus did not need anything. It is logical to assume that after this period, the conditions for bearing become unfavorable, which affects the mother's body and the fetus.

A pregnant pregnancy has several characteristic features:

- Decrease in the amount of amniotic fluid ( hypochlorism in pregnancy ). The amniotic fluid is designed to protect the child from mechanical injuries and provide him with freedom of movement in a delimited cavity. They also participate in metabolic processes and provide the developing organism with immune protection. In the generic process, water plays the role of a kind of provocateur - under the weight of the bladder, the cervix of the uterus opens.

On the eve of delivery, when the fetus is already preparing to come into the world, the amount of water decreases. If the birth is "delayed", the amniotic volume continues to decrease, so the uterus also becomes smaller. Clinically, this is manifested by a decrease in the volume of the stomach and a decrease in the weight of the pregnant woman.

Also, when changing, not only the quantity but also the quality composition of the amniotic fluid changes - it becomes turbid and loses its protective properties, so it can become infected, as a result, the fetus has a threat of intrauterine pneumonia.

- Depletion (aging) of the placenta. At the end of the normal period of gestation, the signs of exhaustion appear in the tissues of the placenta: dystrophic changes in the tissue, thinning of the placental barrier, sclerosis of the vessels, deformation of the chorionic villi and others. Naturally, such processes are reflected in the functions performed by the placenta, and hence - affect the fetus. At the time of repetition, the initial signs of oxygen deficiency ( fetal hypoxia ) are registered for five days already.

- The skin of a pregnant woman loses the physiological turgor (elasticity).

- Compaction of the uterus due to loss of fluid and contraction of muscle fibers.

- The uterine bottom is not sufficiently low, especially if the fruit is large (which is often the case when you are pestering). This is also facilitated by an excessive tone of the uterine musculature.

- Immaturity of the cervix by the 40th week of pregnancy.

If the listed signs are absent, repetition does not correlate with pathology.

Terms of the transferred pregnancy

Overpopulation is considered a calendar concept, that is, it is ascertained when the pregnancy continues for more than 42 weeks. If at the same time none of the examinations revealed any signs of the child's overripe, it is considered that the prolongation of pregnancy is an individual variant of the norm.

To assess the level of damage from over-sowing, several degrees are distinguished:

- 1 degree. The gestation period does not exceed 41 weeks. The condition of the fetus is generally satisfactory, its excessive motor activity and rapid heartbeat can be recorded. With ultrasound scanning, only minor signs of the child's overripe are visualized, and the placenta according to the structure corresponds to a full-term pregnancy.

Amniotic fluid volume was reduced slightly (800 - 600 ml).

Palpatorially the baby's head is located close to the entrance to the pelvic cavity. Vaginal examination reveals a lack of preparedness of the cervix.

- 2 degree. Gestation is 42-43 weeks. Pronounced water retention. The abdominal circumference is reduced, the uterine bottom is palpated high. The fetus has signs of intrauterine hypoxia on the background of aggravated placental insufficiency, as well as all signs of over-ripening. Sheika is not ready for delivery.

- 3 degree. The extreme stage of re-laying, when the gestation period exceeds 43/44 weeks. All compensatory mechanisms of the pregnant woman have been exhausted. The placenta practically does not perform the proper functions, therefore there is a real danger of intrauterine death.

It should be noted that extreme degrees of endured pregnancy are infrequent. After all, pregnant women do not live on an uninhabited island in the absence of doctors, but are under constant dynamic supervision. As a rule, specialists early enough diagnose the initial signs of true hypotension and take appropriate therapeutic measures, so serious complications of a delayed pregnancy are rare.

Diagnosis of a pregnant pregnancy

To ascertain a pregnant pregnancy, it is necessary to determine its term from the very beginning as soon as possible. As a rule, for a more accurate result, it is customary to determine the date of conception by several methods. The term of pregnancy is not determined once, it is refined several times as the fetus develops and the term increases. Initially, the specialist takes into account the last menstruation, the hormonal data and the size of the uterus, and in later terms, ultrasound scanning, capable of "seeing" the placenta, uterus and fetus, as well as comparing the seen with the established term, comes to the rescue.

The diagnosis of overdraft includes not only a statement of the correct gestational age. It is also necessary to determine in what state the fetus is in the womb, and how the child's place "looks" (and therefore functions).

So, the diagnostic activities include:

1. Clarification of the period of pregnancy and the period of expected delivery in all the most reliable ways.

2. Obstetric study:

- measurement of the abdominal circumference;

- Palpation of the uterine fundus (how high it is localized from the exit from the pelvis) and the baby's head;

- ascertaining the degree of mobility of the fetus (in case of low water, it is reduced);

- calculating the weight gain of a pregnant woman.

3. Vaginal examination:

- visual and palpatory assessment of the degree of "maturity" of the cervix, indicating its readiness for childbirth;

- the definition of the presenting part of the fetus and its position relative to the bones of the entrance to the small pelvis;

- Palpation of the bones of the child's skull to establish their density and the condition of fontanelles and stitches.

4. Instrumental diagnostics:

- Doppler. Allows you to register blood flow in the area of ​​attachment of the placenta to the uterus. If the parameters of placental-uterine blood flow are reduced, the placenta is functioning inadequately.

- Cardiotocography. It is carried out for the quantitative determination of the fetal heart rate. The alternation of episodes of tachycardia and bradycardia is characteristic of fetal hypoxia.

- Amnioscopy. Visual assessment of amniotic fluid through the fetal bladder and cervical canal. In connection with the change in the amount and composition of the waters, they become greenish or yellow when they are repainted.

- Amniocentesis. Instrumentally, a small amount of amniotic fluid is extracted, which is then tested for composition. Characteristic for overstimulation is an increase in the content of "harmful" substances (creatinine, urea, lactic acid), total protein, a decrease in glucose concentration.

- Ultrasound scanning. Provides invaluable information about the true size of the uterus, the condition of the fetus and the placenta.

What to do with a delayed pregnancy?

The answer to this survey is unambiguous - trust the experts. Independently can not determine the severity of overstretching and its effect on the fetus, as well as decide on treatment, the pregnant woman can not.

The management of a delayed pregnancy depends on several factors. First of all, you need to make sure that this pregnancy is not prolonged. If true persistence is established as a fact, it is necessary to find out:

- the degree of the transferred pregnancy;

- what is the condition of the fetus;

- the degree of maturity (or immaturity) of the cervix;

- whether there are preconditions for carrying out induced (by means of medicamental stimulation) of natural genera.

If the pregnancy "delayed" for a short while, and the fetus feels satisfactory, there remains hope for a spontaneous onset of labor and their successful outcome. However, if the gestation period exceeds 42 weeks, expectant management tactics are useless and dangerous, and urgent treatment of a delayed pregnancy is necessary.

Each patient with a pregnant pregnancy wants to receive detailed information about the upcoming birth. Unfortunately, standard methods do not exist, and the obstetrician in each specific situation develops an individual strategy, which, first of all, depends on the well-being of the fetus.

Contrary to the incorrect opinion, a pregnant pregnancy does not always finish on the operating table. Overpouching serves only as a relative indication for cesarean section, it is carried out in the presence of:

- "immature" neck, if it is impossible to prepare it for delivery medicamentally;

- pelvic presentation, when the buttocks of the fetus are located at the exit from the uterus, and the head - in the area of ​​its bottom, or any other non-physiological location of the child;

- narrowing of the pelvis;

- pronounced, subcompensated, functional insufficiency of the placenta;

- Circling the umbilical cord around the body, and especially the neck, the child;

- Adverse anamnestic data: severe extragenital pathologies, prolonged infertility , in vitro fertilization, stillbirths.

If the situation allows you to abandon the operation, a medical simulation of the birth process is performed.

Any method of delivery requires prenatal training, including:

- improvement of blood supply in the placenta;

- neck preparation;

- stimulation of the central structures responsible for the generic process.

Consequences of a transferred pregnancy

Complications of a postponed pregnancy can be conventionally classified into prenatal, and those that have arisen after the birth of a child.

Consequences for pregnant women:

- In case of late pregnancy, pregnant women often develop gestosis , changes in blood coagulation and anemia , and lack of water.

Consequences for the fetus:

- hypoxia due to dysfunction of the placenta;

- Asphyxiation in childbirth;

- pathology of the newborn's bronchopulmonary system;

- neurological disorders and skin infections;

- birth injuries due to excessively dense cranial bones (cephalothatoma, skull fractures, hemorrhages);

- death in any of the periods of pregnancy, childbirth and after them.

Consequences realized directly in childbirth:

- untimely outflow of water against the background of an unprepared neck;

- Prolonged preliminaries (preparatory) period;

- anomalies of the generic process: discoordination, weakness;

- too long (protracted) course of the generic process;

- trauma of soft tissues (especially if the fetus is large, and its cranial bones are dense and inactive) mothers;

- premature detachment of the placenta ;

increased risk of bleeding;

- infectious complications in the fetus (more often after birth).

It has been noticed that children with disabilities in physical and intellectual development often lag behind peers (evidently because of prolonged pronounced hypoxia).