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Post-term Birth – Causes, Risks and Treatment

A post-term birth refers to a delivery that occurs after 42 completed weeks of pregnancy. It carries risks for both mother and child and requires close medical monitoring.

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Things worth knowing about "Post-term Birth"

A post-term birth refers to a delivery that occurs after 42 completed weeks of pregnancy. It carries risks for both mother and child and requires close medical monitoring.

What is a Post-term Birth?

A post-term birth – also referred to as a prolonged pregnancy or postdate pregnancy – occurs when a pregnancy extends beyond 42 completed weeks of gestation. The estimated due date is typically at the end of the 40th week of pregnancy. When this date is exceeded by more than 14 days, the pregnancy is classified as post-term. Already from the 41st week onward, a pregnancy is considered late-term and requires increased medical attention.

Causes

The exact causes of a post-term pregnancy are not always clearly identifiable. Several contributing factors have been identified:

Inaccurate due date calculation: Irregular menstrual cycles or late ovulation can lead to miscalculated gestational age.
Genetic predisposition: Post-term pregnancies tend to run in families.
First-time mothers: Women giving birth for the first time have a slightly higher risk of post-term pregnancy.
Male fetus: Statistically, male babies are slightly more likely to be post-term than female babies.
Maternal obesity: Excess body weight has been associated with an increased risk of prolonged pregnancy.

Risks and Complications

As the pregnancy continues beyond 42 weeks, the risk of complications increases, primarily because the placenta may begin to deteriorate in function – a condition known as placental insufficiency. This can compromise the supply of oxygen and nutrients to the unborn child.

Increased risk of low amniotic fluid (oligohydramnios)
Risk of meconium aspiration (the baby passing its first stool into the amniotic fluid)
Higher rates of cesarean sections and assisted deliveries
Increased risk of perinatal mortality (death around the time of birth)
Risk of an overly large baby (macrosomia), which can complicate delivery

Diagnosis and Monitoring

From the 41st week of pregnancy onward, close monitoring is recommended. Diagnostic tools used include:

Cardiotocography (CTG): Monitoring the fetal heart rate and uterine contractions
Ultrasound examination: Assessment of amniotic fluid levels, fetal position, and placental function
Doppler sonography: Measuring blood flow velocity in the umbilical cord vessels and fetal brain
Biophysical profile: A combination of ultrasound findings and CTG to evaluate fetal well-being

Treatment and Labor Induction

Medical guidelines recommend regular check-ups starting from 41+0 weeks of gestation. By 42 weeks at the latest, induction of labor is generally recommended to minimize risks for both mother and baby.

Methods of Labor Induction

Prostaglandins: Hormones administered as a gel, suppository, or tablet into the vagina to ripen the cervix and stimulate contractions
Oxytocin: A labor-stimulating hormone administered intravenously
Mechanical methods: Such as a balloon catheter to dilate the cervix
Amniotomy: Artificial rupture of the membranes performed by a midwife or physician

In some cases – for example when induction fails or signs of fetal distress are observed – a cesarean section (C-section) is performed.

References

Deutsche Gesellschaft fur Gynakologie und Geburtshilfe (DGGG): Guideline Terminiuberschreitung und Ubertragung, AWMF Registration No. 015-065, 2020.
World Health Organization (WHO): WHO recommendations for induction of labour. Geneva: WHO Press, 2011.
Middleton P, Shepherd E, Crowther CA: Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews, 2018.

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