When Your Due Date Comes and Goes…. And You’re Still Pregnant

due-date-calendarSometimes pregnancy feels like a very long wait – especially during the third trimester. But what happens if that long-anticipated due date comes and goes and you have no baby to show for it? Ideally, pregnancy lasts 40 weeks. A baby born before 37 weeks is considered preterm (or premature), between 37-41 weeks is full term, and 42 weeks or later is a prolonged pregnancy. The risks of a prolonged (or post term) pregnancy are potentially quite serious, and by this point your healthcare provider will likely suggest you take action.

What is a prolonged pregnancy?

A pregnancy that has lasted up to or beyond 42 weeks’ gestation is considered a prolonged (post term) pregnancy. This happens in approximately 7% of pregnancies. The challenging decision in cases of prolonged pregnancy is whether to induce labor or to perform a Cesarean, as leaving the baby in the womb beyond 42 weeks dramatically increases the risks of stillbirth and other problems. Some women may be good candidates for induction of labor; others may need a C-section. It depends on the condition of the baby and the readiness of mother’s cervix.

Higher risk of complications

A pregnancy lasting longer than 42 weeks poses some potentially serious complications for your baby. After 40 weeks, your physician will most likely begin monitoring the baby more closely with ultrasounds, non-stress tests, and other techniques as often as twice per week. For your baby, a prolonged pregnancy can lead to:

  • Macrosomia – This term describes infants who are born much larger than average and weigh at or above 8 pounds 13 ounces (4,000 grams). While not always the case, babies of this size often cause difficult labor and
  • Stillbirth – The chances of stillbirth increase from 39 weeks and significantly after 42 weeks.
  • Cesarean – The number of C-sections performed on pregnant women doubles when the pregnancy is prolonged. Your doctor will talk with you about whether or not you are a good candidate to have labor induced; if not, Cesarean section may be your best option.
  • Infant death in the first year of life (SIDS)
  • Dysmaturity syndrome – Some babies born after 42 weeks have a greenish tint to the skin, nails, and umbilical cord, characteristic of dysmaturity syndrome (also known as Ballantyne disease). Other symptoms include decreased alertness after birth and increased respiratory distress.

Baby is not the only one who can have negative health impacts from a prolonged pregnancy – it can be detrimental for mothers, too. Having a large baby can make childbirth much harder and cause severe tearing of the perineal tissue (the tissue between the vagina and the anus), as well as causing some anxiety.

Typical management of post term pregnancy

While every case is unique, many post term pregnancies are managed in a similar fashion. The simplest way to manage a prolonged pregnancy is to avoid it altogether. Accurate pregnancy dating plays an important role in assessing post term pregnancy, so getting prenatal care early in pregnancy is important for determining the baby’s due date. If your baby is testing fine through all the extra monitoring, you may not be induced; it really depends on the opinion of your physician. Generally, though, it is the recommendation to induce labor at 41 weeks if the cervix has some thinning (effacement) and dilation.

Though having a prolonged pregnancy can be tricky, one of the most difficult aspects can be mentally; you’re anxious for this baby to come and unsure of when it will happen! Every woman has a different set of circumstances, so it’s important to work with your doctor and ask plenty of questions. Delivering your baby safely is the top priority!

Did you have a prolonged pregnancy? We’d love to hear your comments!

Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991404/

https://www.aafp.org/afp/2004/1201/p2221.html

https://medical-dictionary.thefreedictionary.com/dysmaturity+syndrome

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