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17 year's old pregnant. Ultrasound done. What are the complications?

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Practicing since : 1999
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My 17 year old daughter is pregnant (approx 40-41 wks). At 24 wks a preliminary ultrasound showed mild bilateral hydronephrosis. She has been under consistent prenatal care and was referred to bi weekly fetal monitoring and anatomical measuring approx every 8 wks. The fluid in the kidneys has reduced since the initial diagnosis. Although, I am becoming very concerned regarding her past due date. She underwent severe stress at times due to the pregnancy at such a young age, relationship issues, family issues, typical stress related to lack of knowledge and experience. She gained approx 60lbs and according to health professionals has not "dropped". She will be approx 41wks Monday and now I am investigating the causes of going past her due date and the possible causes and complications considering her immature body. Please provide the most common situations that occur considering the above and advise accordingly. I have all the anatomical ultrasound reports with measurements etc. but I do not have radiology experience in reading and comparing all of them.

Posted Fri, 10 Aug 2012 in Teen Pregnancy
Answered by Dr. Timothy Raichle 2 hours later

Hello, I would be happy to help you with your question.

First of all, with regard to the fetal status, it sounds like the hydronephrosis improved and twice weekly testing is more than enough to assure the safety of the fetus. This usually involves either monitoring or ultrasound, and the chance of a bad outcome within the week after is very low with normal testing.

Second, beginning Monday, your daughter willl be "post-dates". It is acceptable to actually continue a pregnancy up to 42 weeks, but this is very uncommon these days. We usually like to begin a "move towards delivery" beginning at 41 weeks. This is most often limited by the cervix. The cervix must be "favorable" before undergoing induction of labor. In your daughters case, it does not sound favorable given the lack of descent of the fetus. I am not worried at all about her age or the stresses of the pregnancy - these are not indications for delivery, but a gestational age of 41+ weeks is an indication for delivery.

So at her visit on Monday:
1. They need to recheck her cervix
2. You need to ask what the plan is for delivery THIS WEEK
3. If they are concerned about the lack of fetal descent, then ask for an ultrasound to assess fetal weight
4. If the fetal weight is >4500gm, then you should seriously consider a Cesarean Section for her.
5. Part of the testing that MUST be done tomorrow includes a check of amniotic fluid volume. If this is low (<5) she needs to be delivered that day!!

Please ask if you have more questions. If you are satisfied, please make sure that your ACCEPT my answer so that I receive credit. Good luck!!
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