4. Post-term Labor

what is a post-term pregnancy?

a pregnancy that reaches 42 weeks, 0 days or later

why is post-term pregnancy concerning for fetal health?

the placenta is meant to last about 40 weeks, function can decline after that point

• less oxygen and fewer nutrients may reach the fetus

maternal risks associated with post-term pregnancy

• cesarean birth

• dystocia, birth trauma

• postpartum hemorrhage

• infection

• abruption

fetal risks associated with post-term pregnancy

• macrosomia

• shoulder dystocia

• brachial plexus injuries

• low apgar scores

• post-maturity syndrome

• cephalopelvic disproportion

what is a brachial plexus injury?

injury to the nerves controlling the shoulder and arm

• it may cause arm weakness or loss of movement

how can shoulder dystocia lead to a brachial plexus injury?

stretching of the neck and shoulder can injure the nerves

• excessive traction on the fetal head increases this risk

what is postmaturity syndrome?

changes associated with prolonged pregnancy and reduced placental support

• loss of subcutaneous fat and muscle

• dry, peeling skin

• possible meconium staining

what amniotic fluid problem can develop in a post-term pregnancy?

oligohydramnios

• can cause cord compression

why can meconium-stained fluid be concerning in a post-term pregnancy?

the newborn may aspirate meconium and develop respiratory problems

nursing assessments for post-term labor

• due date

• daily fetal movement counts (notify MD if not felt)

• nonstress test twice weekly

• amniotic fluid analysis

• weekly cervical exams

• clinical understanding, anxiety, coping ability

nursing management for post-term labor

• fetal surveillance

• decision for labor induction

• support

• education

• intra-partal care