Post-term birth

• Definition: Birth after 42 weeks of gestation
• Causes: Unknown; possible factors include inaccurate estimation of due date, genetic predisposition, placental insufficiency
• Signs and symptoms: Wasted appearance due to loss of subcutaneous fat; peeling, cracked, leathery skin; long hair and nails; meconium staining on nails or umbilical cord; macrosomia or intrauterine growth restriction; oligohydramnios (low amniotic fluid volume); fetal distress; hypoxemia; hypoglycemia; polycythemia; hyperbilirubinemia
• Assessment: Determine gestational age using ultrasound or last menstrual period date; measure weight, length, head circumference; monitor vital signs and oxygen saturation; assess for signs of distress or injury; perform heel stick blood glucose test using a glucometer; perform laboratory tests as ordered (e.g., blood gas analysis, hematocrit); perform diagnostic tests as ordered (e.g., chest X-ray)
• Nursing interventions: Deliver the baby vaginally with induction or augmentation of labor if needed or by cesarean section if indicated; provide oxygen therapy if needed; maintain thermoregulation by keeping the baby warm and dry; feed the baby as soon as possible after birth; monitor blood glucose levels frequently until stable; administer IV dextrose solution if needed; monitor hematocrit levels and perform partial exchange transfusion if needed; monitor bilirubin levels and provide phototherapy if needed; educate parents on signs of hypoglycemia and how to feed the baby