PROLONGED PREGNANCY

I grew up with my mom telling my siblings and I a lot of stories about her childhood. My mom is a good story-teller. She gives you all the details, you start to feel like you were there when it happened. I’ve always thought she’d make a great writer, but she’s a teacher, so I guess the talent has been put to good use.

One of such stories mom told my siblings and I growing up was about the birth of her dad. She told us grandpa was carried in his mother’s womb for two years; so much so that the people in her community started to ask what was going on with her pregnancy. Imagine how baffled my siblings and I were, but we all really wondered if it was possible. Training as a doctor and learning a lot about pregnancy made me question that even more. But, grandpa was born in delta state, Nigeria, in Africa, where it is believed that almost anything is possible with “juju”, though we’ll have to question great grandma to gather more information to ascertain if it really was a 2year old pregnancy. Too bad it’s the nature of life for everyone to die at some point.

WHAT IS PROLONGED PREGNANCY?

As a health practitioner, I have never seen a two year old pregnancy, but I have seen some pregnancies extend a few weeks or months beyond the expected 9 months, and it is a great cause of concern to the mother and the doctor, because the unborn baby and the mother could be in harm’s way.

Prolonged pregnancy is defined as a pregnancy which progresses beyond 42 weeks. 

HOW COMMON IS IT?

5-10% of pregnancies are prolonged beyond 42 weeks. About 20% of pregnant women will need induction of labour. In Nigeria, 8-10% of all pregnancies are prolonged. However, accurate pregnancy dating early on in pregnancy and induction of labour at 41 weeks can reduce the occurence to as low as 1%. Incidence decreases when pregnancy date is calculated using an early ultrasound scan

WHAT CAUSES PROLONGED PREGNANCY?

Prolonged pregnancy occurs due to several reasons;

1. Error in estimating the gestational age (age of the pregnancy), based on a wrong date. This is the commonest cause of seemingly prolonged pregnancy (which in reality is not a prolonged pregnancy)
2. Failure of biological mechanisms responsible for the initiation of labour. Due to causes like placental sulphatase deficiency, anencephaly or other central nervous system abnormalities.

Other risk factors for prolonged pregnancy have also been noticed:

1. Previous prolonged pregnancy: Women who have had a prolonged pregnancy are likely to have another prolonged pregnancy.
2. High socioeconomic status: Women of high socioeconomic status are more likely to have prolonged pregnancies (my personal  theory about this is, maybe the baby is enjoying too much in the woman’s womb he/she doesn’t want to come out)
3. Male gender (of the child): pregnancies are likely to be prolonged when the mother is expecting a male child
4. Maternal obesity: Mothers who are obese are also likely to have their pregnancies prolonged
5. Age-elderly moms: Are also at higher risk of having prolonged pregnancy.

WHY IS PROLONGED PREGNANCY A CAUSE OF CONCERN?

Prolonged pregnancy is a cause of concern to both the mother and the doctor because it poses a lot of risks to both the mother and the unborn baby:

1. Risks to the mother:

1. Increased likelihood of having an operative vaginal delivery
2. Tears to the genital tract
3. Increased caesarean section rate
4. Emotional impact, as it creates anxiety and frustration

      B. Risks to the baby:

1. Perinatal mortality: This simply means that the baby is likely to die around the time when it should be born. e longer a pregnancy is prolonged beyond 42 weeks, the more the likelihood of the child dying.
2. Birth trauma: In prolonged pregnancy the baby spends more time in the womb and grows bigger than the expected size. So, the baby may become too big to easily pass through the birth passage of the mother, and may encounter some injuries like skull fractures or shoulder entrapment during the process of delivery, or fracture of other bones.
3. Post maturity syndrome: is a term used to describe the characteristic appearance of some babies who have stayed beyond 42 weeks. They show physical  features such as: 

1. Decreased subcutaneous fat
2. Wrinkled skin
3. Green or yellow staining of the skin
4. Fragile or weak baby

Other complications around such babies may include:

i. Death within the first year of life.

ii. Delay in mental/physical development and lots of other risks.

PREVENTION OF PROLONGED PREGNANCY:

Prolonged pregnancy can be prevented by:

1. Ensuring adequate dating of pregnancy by an early ultrasound scan, preferably an ultrasound scan within the first trimester
2. Membrane stripping by a doctor from 40 week of gestation.

TREATMENT:

As we have seen, prolonged pregnancy can be risky. If you or anyone else is having a pregnancy extending beyond 42 weeks, see a doctor or encourage the person to do so.  It’s advisable for expectant mothers to attend antenatal for progress monitoring of the fetus. Good thing the flexicare health insurance plan covers antenatal, delivery/CS costs.
Your doctor will decide on the best treatment approach. Induction of labour (where the labour is initiated by medical means) is usually the best choice if the mother is able to go through the process of vaginal delivery, and the mother and baby are in good condition after physical assessment.