Dr. Ahdoot shares what women need to know about post-term delivery and a high-risk pregnancy.
Perhaps the most popular question is this. There’s a movement towards doing everything natural, which is a good movement. However, under expeditious and careful management, if a woman has high-risk issues we increase their surveillance before their due date comes. If normal pregnant women in their 20s or 30s with no high-risk issues passes their due date, we again initiate surveillance.
When you enter post date state, there’s a direct increase in relationship of adverse outcome after the due date, and in high-risk patients even sooner than that. Therefore, we initiate monitoring sooner. If the patient has gone over 41 weeks, we even more intensify the monitoring and most physicians recommend risk versus benefits to proceed with delivery.
The issue at hand is, if there’s no labor in sight and if the cervix has not prepared for delivery, then you may be fighting an uphill battle. So imagine a situation where the mother, the fetus, and the mother’s anatomy, the uterus and the cervix, all work in concert. So mother will have inherent signals to begin labor. Baby would be ready for delivery, and the cervix and the uterus respond to those inherent hormonal signals.
If you pass your due date or perhaps even a week or two after your due date and this hasn’t happened, the risks of at risk outcomes can increase, and if high-risk surveillance identifies risk factors then you proceed with delivery. If you have passed your due date or perhaps a week after your due date your cervix is ready for delivery. the fluid around the baby decreases, the movement decreases, or other surveillances turn out to be positive, typically delivery is recommended.
So, to put it on a more human level, oftentimes you find a physician being careful and recommending delivery. Then you find the mother being naturally careful and saying, “I don’t feel like my body is ready,” and the most important thing is for the physician and the patient to work together. They are on the same team. That’s why it’s so important when you first pick your physician or OB/GYN is to make sure you have direct communication, you feel comfortable, and there is trust between the two.
In the absence of any high-risk factors, we typically like to see women go to their due date or even past their due date to see if they will go into natural labor. It obviously decreases their cesarean section rate. However, if there are complications or high-risk issues, then it is important to put more weight on the physician’s recommendations.
When in doubt, we always ask our fellow perinatologists, who basically specialize in high-risk pregnancy, to give us a second opinion, give us an update via ultrasound or their opinion as to whether there’s any high-risk situations we should anticipate or within what period of time we should expect to deliver, whether the cervix is ready or not.
About Dr. David Ahdoot, M.D.:
David Ahdoot specializes in Obstetrics and Gynecology at Saint John’s Hospital in Santa Monica, California. He attended medical school at the University of California San Diego Medical Center. Later he went on to do his internship and residency at the University of California Irvine Medical Center. With more than 16 years experience, Dr. Ahdoot is a Diplomat of the American Board of Obstetrics and Gynecology.