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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Milner, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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1619-3997
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Guidelines for the management of postterm pregnancy

Giampaolo Mandruzzato
  • Head of Division of Obstetrics and Gynecology (emeritus), Instituto per I'Infanzia, Trieste, Italy
/ Zarko Alfirevic
  • University of Liverpool, Liverpool, UK
/ Frank Chervenak
  • Weill Medical College of Cornell University, New York, NY, USA
/ Amos Gruenebaum
  • New York Presbiterian Hospital, New York, NY, USA
/ Runa Heimstad
  • St. Olavs University Hospital, Trondheim, Norway
/ Seppo Heinonen
  • University Hospital, Kuopio, Finland
/ Malcolm Levene
  • University of Leeds, Leeds, UK
/ Kjell Salvesen
  • St. Olavs University Hospital, Trondheim, Norway
/ Ola Saugstad
  • University Hospital, Oslo, Norway
/ Daniel Skupski
  • New York Hospital Queens, New York, NY, USA
/ Baskaran Thilaganathan
  • Head of Division of Obstetrics and Gynecology (emeritus), Instituto per I'Infanzia, Trieste, Italy
  • St. George's Healthcare Trust, London, UK
Published Online: 2010-02-15 | DOI: https://doi.org/10.1515/jpm.2010.057

Abstract

A pregnancy reaching 42 completed weeks (294 days) is defined as postterm (PT). The use of ultrasound in early pregnancy for precise dating significantly reduces the number of PT pregnancies compared to dating based on the last menstrual period. Although the fetal, maternal and neonatal risks increase beyond 41 weeks, there is no conclusive evidence that prolongation of pregnancy, per se, is the major risk factor. Other specific risk factors for adverse outcomes have been identified, the most important of which are restricted fetal growth and fetal malformations. In order to prevent PT and associated complications routine induction before 42 weeks has been proposed. There is no conclusive evidence that this policy improves fetal, maternal and neonatal outcomes as compared to expectant management. It is also unclear if the rate of cesarean sections is different between the two management strategies. After careful identification and exclusion of specific risks, it would seem appropriate to let women make an informed decision about which management they wish to undertake. There is consensus that the number of inductions necessary to possibly avoid one stillbirth is very high. If induction is preferred, procedures for cervical ripening should be used, especially in nulliparous women. Close intrapartum fetal surveillance should be offered, irrespective of whether labor was induced or not.

Keywords: Birth weight; body mass index; postterm pregnancy; ultrasound

Corresponding author: Giampaolo Mandruzzato, MD Via del Lazzaretto Vecchio 9 Trieste Italy


Published Online: 2010-02-15

Published Online: 2010-02-15

Published in Print: 2010-03-01


Citation Information: Journal of Perinatal Medicine. Volume 38, Issue 2, Pages 111–119, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm.2010.057, February 2010

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