Postterm pregnancy: practice patterns of contemporary obstetricians and gynecologists

The purpose of this study was to determine the management of postterm pregnancy by contemporary practicing obstetricians. A questionnaire investigating practice patterns pertaining to postterm pregnancy was mailed to 1000 randomly selected American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in March 2004. The response rate was 52.2% (522/1000). Statistical analysis included the answers from the 420 practicing obstetricians. Males comprised 55.7% (234/420) of the responding obstetricians. The majority of responding obstetricians (95.4%) rated their residency training regarding management of postterm pregnancy as adequate or comprehensive. Forty-eight percent define postterm pregnancy as 42 weeks gestation or greater, whereas 43.1% consider 41 weeks gestation or greater to be postterm. Seventy-three percent routinely induce low-risk patients with singletons at 41 weeks gestation. If patients decline induction at 41 weeks or if the practitioner does not induce patients until after 41 weeks gestation, the majority of respondents (64.8% and 65.0%, respectively) start postterm pregnancy fetal testing in singletons at 41 weeks and obtain testing twice weekly. Most (64.6%) use cervical ripening agents when inducing both nulliparous and multiparous patients with unfavorable cervices. The majority of practitioners (97.3%) do not use prostaglandins when inducing postterm patients with one previous cesarean delivery. Although most respondents manage postterm pregnancy according to recent ACOG educational materials with regard to antenatal fetal surveillance and methods of induction, the majority induce patients with singleton postterm pregnancies at 41 weeks gestation rather than at 42 weeks gestation.