Not Here Yet?

Wellness No. 1

2012

Not Here Yet?

Dr Cynthia Kew (Author)
Consultant, Department of obstetrics & Gynaecology
KK Women’s and Children’s Hospital

Your baby is considered to be late if your pregnancy is two weeks or more beyond the ‘due date.’

A woman’s “due date” or estimated date of delivery (EDD) is at 40 weeks from the first day of the last normal menstrual period. As menstrual cycles varies in women, the EDD is more accurately assessed with early ultrasound scans.

A pregnancy is considered to be “post-term” if it goes past two weeks and more beyond the EDD. The incidence of post-term pregnancies is estimated at about five per cent.

Contributing factors include:

• Never delivered a baby before
• Having had a previous post-term pregnancy
•  The woman being a baby of post-term pregnancy herself
• Obesity
• Expecting a baby boy
• Rare causes like certain birth defects in the baby

Pregnancies which continue past 42 weeks pose certain risks to baby and the mother:

For the baby:

• Stillbirth – baby’s heart stops beating and dies while in the womb
• Meconium aspiration syndrome – baby experiences breathing difficulties after birth from breathing in meconium while in the womb. Meconium is the dark green faecal material in the baby’s intestines passed around the time of birth
• Birth asphyxia – baby does not receive enough oxygen just before, during or soon after birth
• Difficult delivery – shoulder of baby being stuck in the birth canal during delivery
• Birth injuries – increased risk of childbirth injuries because of increased weight of baby4admission to intensive care unit because of low blood sugar levels, fits, breathing and other problems

Apart from problems associates with increased birth weight, the baby may have other problems arising from reduced blood flow in the placenta which affects the supply of oxygen and nutrients from mother to baby.

For the Mother:

• Increased need for Caesarean section
• Problems such as prolonged labour and obstructed labour, and injuries to the birth canal
• Excessive bleeding after delivery
• Inflammation of the amniotic membranes due to infection
• Anxiety

Studies have shown that perinatal mortality at 42 weeks is twice that of that at 40 weeks. It increases by four-fold at 43 weeks and five to seven-fold at 44 weeks. Perinatal mortality refers to the number of stillbirths and deaths in the first week of life.

Because of the risks to mother and baby, many doctors often advise their patients with uncomplicated pregnancies to induce labour at 41 weeks. But if the patients chooses not to, she will be closely monitored until her baby is born.

Induction of labour generally involves using medications to soften and open the cervix, to start uterine contractions. Other methods include sweeping and membrane during internal examination, having unprotected sexual intercourse (prostaglandins in semen is believed to initiate labour) and the use of acupuncture. However there is little data to prove the effectiveness of sexual intercourse and acupuncture to trigger off labour.