Intrapartum monitoring and management of the postdate fetus

Postdate pregnancy presents a difficult problem in both the antepartum and intrapartum periods. Because of the various complications associated with prolonged gestation, the following precautions should be taken during intrapartum monitoring and delivery: 1. Strict criteria must be established for elective induction should it be needed. Elective induction should be limited to those postdate patients with inducible cervices. 2. Extensive intrapartum fetal heart rate and uterine activity monitoring should be done on all patients. Physicians should be alert and ready for intervention and for any possible abnormal finding. Fetal biochemical assessment should be done liberally, especially when meconium is passed. 3. For patients with thick meconium passage, close intrapartum surveillance should be done by both biophysical and biochemical means. During delivery, attention should be given to minimizing the possibility of meconium aspiration. Good neonatal resuscitation is essential. 4. When the estimated fetal weight is 4500 gm or greater, the possibility of shoulder dystocia should be considered. Unless the patient's previous obstetric history or the progress of labor suggests a possible successful vaginal delivery, cesarean section should be considered.