prolonged pregnancy
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The article is devoted to the current problems of obstetrics, perinatology and neonatology. The article presents a literary review and covers scientific views on the factors of births and hazardous factors that lead to transfer and prolonged pregnancy. The most common perinatal complications of a delayed pregnancy are stillbirth, asphyxia, and birth trauma. Neonatal morbidity in premature infants is 29% and perinatal mortality is 19%, which is higher than in preterm infants. If the pregnancy is 43 weeks or more, these rates will increase. All of these diseases are associated with a decrease in the fetal resistance to hypoxia due to the large size of the brain and morphological changes in the placenta. Therefore, the incidence of meconium aspiration syndrome and fetal distress syndrome at birth increases, leading to high perinatal morbidity and mortality.

Objectives. The aims of this study were to clarify the following: (1) how often does prolonged pregnancy ≥34 weeks occur in patients with emergent cerclage without progesterone and (2) the risk factors preventing such pregnancy continuation. Materials and Methods. This retrospective observational study was performed using medical records of patients for whom emergent cerclage had been performed between April 2006 and December 2018 in our institute. Results. Emergent cerclage was performed in 123 patients (median age: 34, interquartile range: 31–36). Primiparous patients numbered 44 (36%). A history of spontaneous preterm birth (SPTB) was present in 30 (24%). The median presurgical cervical length (CL) was 16 (8–21) mm at surgery. Of the 123, 20 (16%) were delivered at 33 + 6 weeks or less (<34 weeks). We conducted logistic regression analysis of the risk factors of SPTBs <34 weeks after cerclage. Three risk factors were identified that increased the risk of SPTB <34 weeks: presurgical CL 0 mm (odds ratio (OR): 5.30; 95% confidence interval (CI): 1.58–17.7), a history of SPTB (OR: 4.65; 95% CI: 1.38–15.7), and the presence of sludge (OR: 4.14; 95% CI: 1.20–14.3). Conclusion. Three risk factors predicted SPTB <34 weeks after emergency cerclage without progesterone administration: unmeasurable CL (CL 0 mm), a history of SPTB, and the presence of sludge on ultrasound. SPTB <34 weeks occurred after emergency cerclage in 16% of patients, being comparable with the recent data with progesterone.

<p>The voice of women's experience of prolonged pregnancy and induction of labour is largely absent in the literature. This research relays and reflects upon the stories of four women who were induced because their pregnancies were overdue.  The date a woman's baby is due has assumed huge significance. However our methods for dating a pregnancy remain imprecise. Despite this, a very precise timing is recommended by some practitioners as to when to induce, since increasing length of pregnancy increases level of risk of morbidity or mortality to some babies.  For the women awaiting the onset of labour and their families, the undercurrents, which affect the milieu as the days pass, include powerful dichotomies. For example the best available research makes a clear recommendation to intervene but reinforces the woman's choice of management, suggesting that it is acceptable to choose to wait. Women experience emotional vulnerability due to apprehension both about continuing to wait, and about having the increasing likelihood of an induced labour. This is a decision that comes closer and closer, yet may not be necessary - a tense 'race' of sorts is in progress. Women experience mounting physical and social pressures, and a generalised, escalating frustration. Some of the common assumptions made about what it is like for women are that it is a struggle to accept the concept of the unreliability of the due date, to parry well meaning but unhelpful comments and the associated pressure, and to remain confident and phlegmatic when there is an alternative to waiting. An increasing number of women go on to be induced. The primary indication cited is 'prolonged pregnancy'.  I have employed a narrative approach, using a feminist process and story telling, to convey the experience of being overdue and being induced, together with commentary informed by the literature and reflection on practice. Here women are speaking to women. The vivid detail and openness of the stories engrave messages to caregivers regarding women's needs for support while waiting, and for more information. The stories repeat messages documented in research carried out 25 years ago. Women require best available information, wish to be included in decision making, and should be encouraged to question their midwives and other caregivers on all aspects of pregnancy and proffered interventions.</p>

<p>The voice of women's experience of prolonged pregnancy and induction of labour is largely absent in the literature. This research relays and reflects upon the stories of four women who were induced because their pregnancies were overdue.  The date a woman's baby is due has assumed huge significance. However our methods for dating a pregnancy remain imprecise. Despite this, a very precise timing is recommended by some practitioners as to when to induce, since increasing length of pregnancy increases level of risk of morbidity or mortality to some babies.  For the women awaiting the onset of labour and their families, the undercurrents, which affect the milieu as the days pass, include powerful dichotomies. For example the best available research makes a clear recommendation to intervene but reinforces the woman's choice of management, suggesting that it is acceptable to choose to wait. Women experience emotional vulnerability due to apprehension both about continuing to wait, and about having the increasing likelihood of an induced labour. This is a decision that comes closer and closer, yet may not be necessary - a tense 'race' of sorts is in progress. Women experience mounting physical and social pressures, and a generalised, escalating frustration. Some of the common assumptions made about what it is like for women are that it is a struggle to accept the concept of the unreliability of the due date, to parry well meaning but unhelpful comments and the associated pressure, and to remain confident and phlegmatic when there is an alternative to waiting. An increasing number of women go on to be induced. The primary indication cited is 'prolonged pregnancy'.  I have employed a narrative approach, using a feminist process and story telling, to convey the experience of being overdue and being induced, together with commentary informed by the literature and reflection on practice. Here women are speaking to women. The vivid detail and openness of the stories engrave messages to caregivers regarding women's needs for support while waiting, and for more information. The stories repeat messages documented in research carried out 25 years ago. Women require best available information, wish to be included in decision making, and should be encouraged to question their midwives and other caregivers on all aspects of pregnancy and proffered interventions.</p>

Abstract Introduction The aim of this trial was to evaluate the effect of maintenance treatment with vaginal progesterone gel compared to placebo in preventing preterm birth after the onset of preterm labor.Methods A randomised controlled trial in Sweden in 2009 − 18. Women with preterm labor were randomized to daily doses of progesterone gel 90 mg (n = 29) or placebo (n = 29) after standard treatment with intravenous tocolytics. Women with intravenous tocolytics alone served as controls.Results The latency to delivery was 58 ± 34 days with progesterone and 64 ± 51 days with placebo (p = 0.83), compared to 2 ± 2 days in the control group (progesterone and placebo vs control p < 0.001). The rate of preterm birth before 34 weeks was 34 % after progesterone and 38 % after placebo (p = 0.34) compared to 100 % in the control group (p < 0.001 respectively). The composite neonatal morbidity (p = 0.65) and neonatal intensive care unit admission (p = 0.12) were comparable between the progesterone and placebo groups, but lower in these groups compared neonates of women in the control group (p < 0.001 respectively). Conclusion Maintenance treatment with progesterone gel and placebo were equally effective in preventing preterm birth among women with preterm labor. Both progesterone and placebo prolonged pregnancy more effectively than intravenous tocolysis alone. We hypothesize, that the acidic gel base reinforced the biochemical barrier at the uterine cervix, which counteracted ascending pathogen invasion and subsequent inflammation and thereby delayed preterm birth. The present results suggest, that non-hormonal agents that reinforce the biochemical cervical barrier can be useful for the prevention of preterm birth in clinical practice.

Abstract Background The intrapartum management of prolonged pregnancies is aunique challenge to the obstetricians, as the perinatal outcomes areadverse after completed 40 weeks. In such cases, intrapartumasphyxia and meconium aspiration are associated with almost. Objective To comparison between MVP and AFI in predicting neonatal respiratory outcomes in induction of labour in prolonged pregnancies. Patients and Methods The study was a prospective comparative study that was conducted on 266 women with prolonged pregnancy undergoing induction of labour. The patients were recruited from Ain Shams university hospitals during the period from February 2019 to August 2019. Results Amniotic fluid index and MVP were evaluated in 269 women with pregnancies of 40 or more weeks and intact membranes using a 3.5-MHz linear transducer. Both measurements were obtained for each participant by the same obstetrician in one sitting. Oligohydramnios was defined as an AFI of 5 cm or less or an DVP of 1 cm or less. External cardiotocography was performed during intrapartum period in all cases. Fetal distress was diagnosed when any one of the nonreassuring fetal heart rate pattern occurred or when the Apgar score at birth was 6 or less. The results were analyzed by the chi(2) and the t tests. Conclusion The use of the AFI and SDVP is useful in predicting neonatal outcomes in the induction of labor in prolonged pregnancies. The SDVP measurement appears to be the more appropriate method for predicting neonatal outcomes. The same observation was found when AFI and SDVP were combined. It is also logical to recommend that only one method should be used for fetal assessment tests.