PROLONGED PREGNANCY: WHAT TO EXPECT AND HOW TO PREPARE

Prolonged pregnancy, also known as post-term pregnancy, is defined as a pregnancy that extends beyond 42 weeks of gestation (294 days) from the first day of the last menstrual period. This condition occurs in approximately 5-10% of pregnancies and is characterized by the failure to initiate labor within this time frame. The normal duration of a pregnancy is typically around 40 weeks, and when it surpasses this period, various physiological changes occur in both the mother and fetus.

Possible Complications of Prolonged Pregnancy

Prolonged pregnancy can lead to several complications for both the mother and the fetus:

1. Fetal Complications:
   • Oligohydramnios: Decreased amniotic fluid levels can occur due to placental aging, which may compromise fetal well-being.
   • Macrosomia: Larger-than-average babies are more likely in prolonged pregnancies, increasing risks during delivery.
   • Meconium Aspiration Syndrome: The risk increases if meconium is passed into the amniotic fluid, potentially leading to respiratory issues for the newborn.
   • Stillbirth: There is an increased risk of stillbirth after 42 weeks due to placental insufficiency.
2. Maternal Complications:
   • Increased Risk of Cesarean Delivery: As labor progresses or fails to progress adequately, there may be a higher likelihood of needing a cesarean section.
   • Infection: Prolonged rupture of membranes can increase infection risks for both mother and baby.
   • Postpartum Hemorrhage: The risk may be elevated due to uterine atony or retained placenta.
3. Placental Complications:
   • Placental Insufficiency: The placenta may become less effective over time, affecting nutrient and oxygen delivery to the fetus.

Available Method for Induction of Labor

Induction of labor refers to medical interventions used to stimulate uterine contractions before spontaneous labor begins. Methods include:

1. Pharmacological Methods:
   • Prostaglandins (e.g., Misoprostol): These medications help soften and dilate the cervix while stimulating contractions.
   • Oxytocin (Pitocin): This synthetic hormone is administered intravenously to induce or augment labor by increasing contraction frequency and intensity.
2. Mechanical Methods:
   • Foley Catheter Insertion: A catheter can be inserted into the cervix and inflated to promote cervical dilation.
   • Membrane Stripping: A healthcare provider manually separates the membranes from the cervix during a vaginal exam, which may release prostaglandins naturally.
3. Amniotomy (Artificial Rupture of Membranes): This procedure involves breaking the water bag surrounding the baby to stimulate contractions.
4. Herbal Remedies & Acupuncture: While some women seek alternative methods like herbal supplements or acupuncture, these should only be considered under professional guidance due to varying efficacy and safety profiles.

Main Indications for Induction of Labor in Obstetrics

Indications for induction of labor include:

1. Post-Term Pregnancy: To reduce risks associated with prolonged gestation.
2. Maternal Health Conditions:
   • Hypertension or preeclampsia necessitating early delivery for maternal safety.
   • Diabetes mellitus requiring control over fetal growth patterns.
3. Fetal Complications:
   • Fetal growth restriction or intrauterine growth restriction (IUGR).
4. Premature Rupture of Membranes (PROM): When membranes rupture before labor starts but without signs of infection.
5. Chorioamnionitis: Infection in amniotic fluid necessitating prompt delivery.

Contraindication of Induction of Labor

Contraindications for induction include:

1. Placenta Previa: Where placenta covers part or all of the cervix posing bleeding risks during contractions.
2. Vasa Previa: Blood vessels running across or near cervical opening can rupture during induction leading to fetal hemorrhage.
3. Uterine Scar from Previous Surgery: Risks associated with uterine rupture if there’s a history of classical cesarean section or other major uterine surgery.
4. Severe Fetal Distress: If there are signs that indicate immediate cesarean delivery would be safer than induction.
5. Certain Maternal Conditions: Such as active herpes infection or severe cardiac disease where stress from labor could endanger maternal health.

Major Complications of Induction of Labor

Inducing labor carries potential risks including:

1. Uterine Hyperstimulation: Excessive contractions can lead to fetal distress or uterine rupture.
2. Increased Need for Cesarean Delivery: If induction fails or complications arise, emergency cesarean sections may become necessary.
3. Infection Risk: Both maternal and neonatal infections can occur due to invasive procedures like amniotomy or catheter insertion.
4. Postpartum Hemorrhage: Increased uterine activity can lead to atony (failure to contract), resulting in excessive bleeding after birth.
5. Fetal Complications: Including but not limited to low Apgar scores at birth due to stress from hyperstimulation or other factors related to induction methods used.