Evaluation and management of postdate pregnancy

Postdate pregnancy (more than 42 weeks' gestation) accounts for about 10 percent of obstetric deliveries. Maternal and fetal assessment in anticipation of postdate pregnancy must begin early in the pregnancy. Gestational age must be accurately determined through judicious use of historical, physical and laboratory data. Familiarity with the physiologic changes associated with pregnancy, both near and after term, can help in predicting the possibility of neonatal morbidity from fetal macrosomia or dysmaturity, placental insufficiency and meconium-stained amniotic fluid. Management of the postdate pregnancy includes antenatal testing to measure fetal well-being. If testing indicates fetal distress or absent amniotic fluid, immediate delivery should be initiated. Cervical ripening should be considered if the Bishop score indicates an unfavorable chance of successful induction and if there is no need for immediate delivery. When labor commences after 42 weeks' gestation, continuous fetal monitoring is essential.