The postmaturity

The postmaturity is the continuation of the pregnancy is 14 days or more over the estimated period (if peremeshivanie the duration of pregnancy equals 294 days or more).
To establish the true duration of pregnancy is difficult, as the historical data of pregnant are not always accurate. In most cases, pregnancy and childbirth, accompanied by peremeshivanie, do not cause any complications in the mother or the fetus, but mertvorozhdennosti when postmaturity big time increases and occasionally there antenatal and intrapartum-related mortality, be explained other than P. b., the reasons.
Etiology P. B. still not installed. Some authors believe that P. B. due to the influence of the yellow body, its braking effect on the motor function of the uterus, other link the postmaturity low concentrations oksitotsicheskogo substances (pitocin and acetylcholine) in the blood to these women. EEG studies showed that under section b. there is a weakening of the restorative effects of the reticular formation in the cerebral cortex.
Pathological anatomy. Sometimes in the placenta during P. B. on the maternal surface are lime deposits ("ageing" of the placenta)observed quite often and for urgent delivery. Microscopic examination of the placenta special deviations from the normal structure is not noted. Majorsince space often narrowed, with accumulations fibrinogen masses; described in section b. the appearance of additional areas (compensatory) growth of the villi.
Over and symptoms of pregnancy and childbirth when peremeshivanie do not have any distinctive features. P. B. observed as in nulliparous and multiparous, but in nulliparous adverse outcomes occur more frequently; this especially applies to "age" perforadas. Birth in section b. often complicated by a primary generic weakness, sometimes with premature discharge of water. When postmaturity in the period of expected birth often appear a little bit of pain, and pregnant comes into the hospital; the pain is irregular, rare, weak and soon completely cease. Mortality fruit grows in parallel duration P. B. The fetus with P. B. usually more of a medium size and is somewhat longer; often noted a significant amount of the head, the density of the bones of the skull with the narrowness of the sutures and fontanelles, which reduces the ability of the head to the configuration change. Overdue newborns have a small amount of skin lubrication - the skin is dry, scaly, there are often partial maceration and puckering. In radiography at a late neonatal well-developed state of the kernel of ossification of the proximal epiphysis of the tibia and shoulder bones. You should also consider the development of nuclei of ossification of the foot - cube-shaped bone. X-ray examination in pregnant limited due to the undesirability of exposure and the difficulty of assessing the extent of cores.
One of the most important signs of peremeshivaniya pregnancy is the change of the amount and type of amniotic fluid. With a significant degree of P. B. (more than three weeks) little water, they have a turbid green color; the umbilical cord and membranes of the placenta is also green. Oligohydramnios proves the violation of water formation; admixture meconium is evidence of fetal hypoxia, which is found out by some authors in the study of umbilical cord blood. The decrease of oxygen and increase of hemoglobin in parallel with the increase of the term P. B.
The diagnosis. The main data on the basis of which is diagnosed P. b., is accurately collected in consultation anamnesis (the date of the last menstruation, the beginning of perturbations). When the diagnosis should be aware that when P. B. the fruit is often quite large.
According to G. K. Stepankovsky, when postmaturity abdominal circumference after the last delivery date is reduced. Showing that, under section b. the cervical canal is usually open on 1-2 finger and not longer than 2 see also asked to identify the sensitivity of the pregnant to oxytocin; this test sets ready for childbirth, but not the degree of threat to the foetus. About the risk to the fetus can be judged by estriol excretion in daily urine of pregnant women.
In P. B. two weeks estriol excretion usually remains sufficient; if excretion of more than 8 mg per day there is no threat of intrauterine fetus; the declining estriol up to 4 mg forecast for fetus is rapidly deteriorating.
More accessible to determine P. B. is cytological examination of vaginal smear. At the end of pregnancy in the vaginal smears detect mainly scaphoid cell squamous epithelium, located in groups; the delivery date cells are single or in small clusters, see the white blood cells. In P. B. scaphoid cells disappear and are replaced basal and parabasal; also appear with eosinophilic pinnatisected nuclei of cells.
Recently, attempts are made to determine the nature of amniotic fluid before the birth.
Treatment. Proposed various ways therapy peremeshivaniya pregnancy. Most midwives believes that the number of signs indicating P. b., should induce labor, as long P. B. (up to three weeks) may result in unexpected prenatal death of the fetus. Indications for delivery may occur after two weeks of peremeshivaniya, so these pregnant should stationgreat in maternity hospital; from this rule should be excluded pervoverhovnyh under the age of 25 years who have severe forms of P. B. with unfavorable outcomes to the fetus are rare.
Indications for the artificial delivery should be set taking into account the history and data, objective research of the pregnant woman (the value of the fetus, the water, the state of the cervix and other). In favor of delivery inclines a large quantity of fruit, just installed anamnestic data.
There are medicamentous and the so-called mechanical artificial methods of delivery. Many obstetricians considered valid only the use of drug delivery. To this end, apply the techniques proposed for therapy generic weakness (see Childbirth, pathology). In the absence of the effect of stimulation in a few days you have to repeat it.
A number of authors in favour of opening membranes. The method can be applied, provided that the head was inserted or pinned to the entrance of the small pelvis ajar when the cervix. Before opening the fetal bubble is desirable to test the sensitivity to oksitotino. To do this, prepare a solution of oxytocin 40% glucose containing 1 ml of 0.01 IU of oxytocin, and introduce it slowly intravenously at a rate of 1 ml per 1 min. before occurrence of the first fight. If 0,01 - 0,03 ED gave battle, we can assume the ready to leave". Opening of membranes produced in acepting conditions. For large fruit and possible inconsistencies head and pelvis against opening membranes should be avoided. After opening the fetal bubble is called generic activities drip oxytocin [1 ml (5 UNITS) in 500 ml of 5% glucose solution under the strict control of the number of drops]. Start with 12 drops of a 1 minutes, gradually ucama introduction of a solution; the bout should be a normal rhythm, as in overdose can occur tetanicescie uterine contractions, followed by asphyxia fruit.
In some cases, when postmaturity shown caesarean section (see). This includes nulliparous after 30 years and the period of infertility and pelvic when previa.
A special form, section b. are so-called failed childbirth, when antenatal killed the fruit of labor activity does not start in time, nor in the coming weeks. In these rare cases, in the first place should be excluded abdominal pregnancy (on the basis of the anamnesis, palpation and radiography). When the diagnosis of failed delivery after waiting several weeks shown artificial delivery, but only medicamentous methods, as all mechanical methods can easily lead to the emergence of infectious process.