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Expectant management versus delivery If a low-risk pregnancy has reached 41 weeks, it can be approached either via expectant management, or labor inducing. Induction of labor using one dose vs. Conclusions The management of postterm pregnancies remains a challenge for obstetricians, deciding which patients are indicated to have labor induced, which will respond to induction, and which ones require C-section. The recommended dose for inducing labour is µg 21, Fetal, neonatal and maternal complications associated with postterm pregnancies have always been underestimated. Primul tip este reprezentat de caseta aplicata, care se monteaza in lacasul unei usi sau a unei ferestre.

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Therefore, it is widely accepted that the ultrasonographic measurement of crown-rump length CRL having an error of 4. The pathophysiological basis for the increased fetal risk in postterm pregnancies is unclear, although it has been long suggested the role played by the placental senescence; the most frequently associated fetal risk of the postterm pregnancy is the meconial aspiration syndrome. Thus, the question remains: when should the intervention for delivery outrun the expectative management?

Keywords prolonged pregnancy, induction of labor, conservative management, accurate dating Rezumat În România, sarcina depăşită cronologic este definită ca o sar­ci­nă cu durată mai mare de 41 de săptămâni şi 0 zile.

Astfel, este acceptat pe scară largă cochrane online dating măsurarea ul­tra­so­no­gra­fică în primul trimestru a lungimii cranio-caudale CRL em­brio­nare cu o eroare de 4,7 zile este metoda cea mai pre­cisă de a determina vârsta gestaţională, fiind superioară biometriei fetale exclusive din trimestrul al doilea.

Ba­za fiziopatologică pentru creşterea riscului fetal în sarcina su­pra­pur­tată este neclară, deşi se consideră de mult timp teoria senescenţei placentare; complicaţia fetală asociată cu sarcina suprapurtată este sindromul de aspiraţie meconială. Astfel, întrebarea rămâne: la ce vârstă gestaţională intervenţia pentru naştere devansează managementul expectativ?

Cuvinte cheie sarcină suprapurtată travaliu indus management expectativ datare corectă Introduction The gestational age which falls between 37 weeks, 0 days and 41 weeks, 0 days is considered to be a term pregnancy 1. According to the National Health Organization, postterm pregnancy is defined as having a gestational age over 42 weeks over daysbeginning on the first day of the last menstrual cycle, and occurs in 1.

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Prolonged pregnancy is stated as having a gestational age between 41 weeks, 0 days and 41 weeks, 6 days. Changes brought into the paraclinical methodology have led, however, to a decline in the number of cochrane online dating births. Determining gestational age by calculating time elapsed since the first day of last menstrual cycle usually leads to overestimation due to lengthy and often unpredictable follicular phase.

Ultrasound dating reduces the risk of incorrectly labeling a pregnancy as postterm.

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It is therefore widely accepted that first-trimester ultrasound measuring of embryo CRL crown-rump length is the most precise method for determining gestational age, having an error margin of 4. Cochrane online dating factors for postterm pregnancy The etiology of postterm pregnancy is usually poorly understood. Some of the known risk factors are listed in Table 1.

Table 1. The risk rises from 0.

Sarcina depăşită cronologic – riscuri şi management

Particularly, the risk of attention deficit and hyperactivity disorder was nearly two-and-a-half times greater in postterm children CRH is the main regulating factor of hypothalamic-pituitary-adrenal axis. Therefore, poor development of this axis can lead to neuroendocrine disorders which can cause behavioral issues and increased emotional vulnerability of affected children. A study made by Danish National Birth Register between and has linked postterm pregnancy with a slightly higher risk of epilepsy in children aged years old 8.

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The pathophysiological ground for increased fetal risk in postterm pregnancy is unclear, although placental senescence has long been considered The most significant complication is intrauterine fetal demise, which has decreased considerably, in having been estimated at 1. Meconial aspiration syndrome causes a notable degree of morbidity and mortality, being most clearly associated with postterm pregnancy, with a risk of 0.

Postterm pregnancy – risks and management

A statistical analysis has shown an increased rate cochrane online dating meconial aspiration syndrome, C-section, and abnormal fetal heart rate in the expectant management group, compared to the above week pregnancy group where labor was induced Other fetal complications include low Apgar score, neonatal convulsions 1.

Fetal evaluation Studies are yet inconsistent regarding the type and frequency of cochrane online dating assessment. Despite the fact that there is no superior method for antenatal assessment of postterm pregnancy, most experts recommend external cardiotocography or biophysical profile and evaluation of amniotic fluid index twice weekly.

It is not recommended to measure the amniotic fluid index in the four quadrants which defines oligohydramnios as lower that 5 cm ; a single 2x2 cm amniotic fluid pocket is considered normal cochrane online dating.

cochrane online dating

Expectant management versus delivery If a low-risk pregnancy has reached 41 weeks, it can be approached either via expectant management, or labor inducing. The question remains: at what gestational age should intervention supersede expectant management? High-risk pregnancies diabetes mellitus, arterial hypertension, or maternal age above 35 years old ce căutați pentru întâlnirile înțelepte most suitable for delivery around weeks.

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The management of low-risk pregnancies is more controversial. The decision to induce labor requires the consideration of several factors, including prenatal fetal assessment, un favorable cervical condition, cochrane online dating online dating age, maternal risk factors and patient preference. A study conducted in England has noted shorter labors and more frequent and intense contractions in the group where labor was induced at 41 weeks compared to the expectant management group, regardless whether labor was later induced or spontaneous Analyzing the means to prevent postterm preg­nancy, a Cochrane analysis has shown that inferior pole amniochorionic membrane sweep, with stimulation of Ferguson reflex in pregnant women who are close to their due date, reduced this risk.

The number cochrane online dating inferior pole membrane sweep maneuvers necessary to prevent chemically induced labor was eight 8. Expectant management does involve elevated anxiety in patients, however they do not perceive it to be a significant medical issue 5.

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Delivery Additional situations where inducing labor is recommended 8 : Oligohydramnios assessed via ultrasound. Non-reactive cardiotocography with positive oxytocin test or biophysical profile greater than 6.

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A predictive clinical factor for favorable induction of labor is a Cochrane online dating score it assesses fetal station and cervical dilation, ripening, consistency and position of more than 6. A study found that cervical shortening and low BMI are better predictive factors than the Bishop score 8. For cochrane online dating labor, the election method consists of administering prostaglandins, except in case of scarred uterus — the risk of uterine rupture being higher with prostaglandins 2.

Therefore, labor should not be induced in case of scarred uterus, spontaneous labour at weeks having a better prognosis than prostaglandin-induced labor. Prostaglandins may be administered intravaginally or orally; some studies claim the superiority of oral administration for inducing labor The recommended dose for inducing labour is µg 21, Prostaglandin tablets available in Romania are between and µg, requiring the obstetrician to fragment them.

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Table 2. Cochrane analysis The recommended treatments are one tablet at 6-hour cycles maximum of two doses — a second dose only if labor has cochrane online dating commencedor one cycle of prolonged-release prostaglandin one dose every 24 hours cochrane online dating Table 3.

Two Cochrane meta-analyses In Romania, the only prostaglandin product designed for inducing labor is a controlled-release vaginal device, which releases misoprostol at approximately 7 micrograms per hour for 24 hours Misodel® micrograms, vaginal release system, FERRING GMBH — Germany. Another means for triggering labor is oxytocin administration, used in case of favorable cervical conditions Bishop score of 5.

A study has shown the effectiveness of administering prostaglandins vaginally, 12 hours before administering oxytocin: prostaglandins bear a tight interaction with oxytocin, mobilizing the arachidonic acid in membrane phospholipids and initiating cyclooxygenase gene 2 transcription, which ensures the continuous synthesis of prostaglandins The C-section recommendation for fetal distress has been examined for each week, at 39 weeks being This risk has been noted to be greater in nulliparous cases compared to multiparous ones.

The risk of instrument-assisted delivery is double at cochrane online dating weeks Conclusions The management of postterm pregnancies remains a challenge for obstetricians, deciding which patients are indicated to have labor induced, which will respond cochrane online dating induction, and which ones require C-section. Fetal, neonatal and maternal complications associated with postterm pregnancies have always been underestimated.

This is the reason why ultrasound screening during the first trimester will reduce the number of false diagnoses of postterm pregnancies. Regarding the management, numerous Cochrane analyses have shown that inducing labor at 41 weeks yields a lesser risk of perinatal mortality and morbidity, when compared to expectant management.

At this gestational age, it is pertinent to consider the chemical termination of pregnancy. Conflict of cochrane online dating The authors declare no conflict of interests. Recurrence rate and outcome of postterm pregnancy, a national cohort study. First trimester ultrasound screening is effective in reducing postterm labor induction rates: A randomized controlled trial. Am J Obstet Gynecol. Increased neonatal mortality among normal-weight births beyond 41 weeks of gestation in California.

Guidelines for the management of postterm pregnancy.

J Perinat Med. Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis. Obstet Gynecol. Genetic influence on prolonged gestation: A population-based Danish twin study. Wang M, Fontaine P. Common questions about late-term and postterm dating whatsapp. Am Fam Physician.

American College of Obstetricians and Gynecologists. Practice bulletin no. Taipale P, Hiilesmaa V. Predicting delivery date by ultrasound and last menstrual period in early gestation. Etiology and pathogenic mechanism of neonatal hypoxic-ischemic encephalopaty. Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination.

Immediate perinatal outcomes of postterm deliveries. J Matern Fetal Neonatal Med. Post-term birth and the cochrane online dating of behavioural and emotional problems in early childhood. Int J Epidemiol. Senat MV. Management of postterm pregnancies: the role for AFI, biophysical score and Doppler. J Gynecol Obstet Bio R. Acta Obstet Gyn Scan. Study protocol of SWEPIS a Swedish multicentre register based randomised controlled trial to compare induction of labour at 41 completed gestational weeks versus expectant management and induction at 42 completed gestational weeks.

BMC Pregnancy Childbirth. Oral misoprostol for induction of labour.

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Cochrane Database Syst Rev. Induction of labor using one dose vs. Simplifying oral misoprostol protocols for the induction of labour.

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Intracervical prostaglandins for induction of labour. Indications and contraindications of vaginal birth post C-section.

Articole din ediţiile anterioare Actualităţi în conduita terapeutică a ruperii premature şi precoce a membranelor Roxana Bohâlțea, Natalia Ţurcan, Costin Berceanu, Şerban Nastasia, Ioniţă Ducu, Monica Mihaela Cîrstoiu Ruperea prematură şi precoce a membranelor fetale PPROM se referă la ruperea membranelor înainte de 37 de săptămâni de gestaţie, în absenţa trava