Post Term Pregnancy, Postmature Baby and Postmaturity
An infant delivered after it has completed 42 weeks of gestation is said to be a postmature baby and the whole pregnancy is called a post term pregnancy . Postmaturity has its own set of problems but they are not as severe as those of prematurity.
- Postmaturity does not occur as frequently as prematurity. The exact reason or the risk factors for postmaturity are not known.
- As the pregnancy nears the end of the normal term, the placenta starts aging and its functional capacity reduces, resulting in lesser nutritional and respiratory support to the unborn baby.
- Babies born postmaturely look weak and emaciated due to lack of adequate nutrition towards the end of their stay in the womb. Skin may be dry and hanging loose; it may be peeling at places too.
- The treatment involves providing nutritional support and care to the infant. It may be necessary to resuscitate some babies born postmaturely.
Placental insufficiency which develops towards the end of gestation is a risk to the life and well-being of the fetus as it remains inside the mother’s womb even after completing the term. Nearer to term, placenta begins to shrink and the nutrition and oxygen passed on to the fetus reduce considerably. To make up for the reduced nutritional support the fetus uses up its store of fat tissue and carbohydrates for energy. A post term pregnancy usually leads to weight loss and growth retardation.
The fetus is severely distressed by the reduced oxygen supply and may pass its intestinal content called meconium into the amniotic fluid. During delivery, if the placenta has become too inadequate, the severe lack of oxygen can lead to brain damage and injury to vital organs. The amniotic fluid tainted with meconium may be inhaled by the fetus as it gasps for breath due to lack of oxygen supply, resulting in meconium aspiration syndrome when the infant is delivered. This can precipitate low oxygen levels in the blood even when the infant starts breathing on its own. The newborn baby remains lethargic due to this.
The postmature baby usually has hypoglycemia or low blood levels of glucose as it may have already exhausted its store of fats and sugars. The skin becomes wrinkled and loose, as the subcutaneous fat tissue (the layer of fat under the skin) has been used up.
Symptoms
The most noticeable symptom of a postmature baby is the appearance of its skin. It is loose and dry, and it may be peeling away at places. Severe loss of subcutaneous fat gives an emaciated look to the postmature baby. Nails on the fingers and toes may be very long. They may look greenish if meconium from the digestive tract of the baby had got mixed in the amniotic fluid. Umbilical cord also may become green due to this.
Treatment
When the baby is born with fetal distress due to lack of sufficient oxygen supply, it is resuscitated immediately. Presence of meconium in the amniotic fluid indicates the possibility of meconium aspiration by the fetus. If the baby is found to be listless, a tube is inserted into the trachea or the windpipe to remove as much of the inhaled meconium as possible by suctioning it out. Ventilator support is given to the newborn if respiratory distress continues, as the meconium may have entered the lungs.
To prevent hypoglycemia and maintain normal blood sugar levels, glucose is administered intravenously. The baby is breastfed frequently, or frequent feeds of formula milk are given. Additional nutritional support is also given, if necessary.
If the infant is not showing any sign of complications due to postmaturity, adequate nutritional support and good post natal care will help the baby gain weight rapidly and catch up with other infants of the same age.
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Yasser Elnahas
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