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Late-Term and Post-Term Pregnancy

Contributor: Francis Nuthalapaty, MD
Last Update: 12/2017

Introduction:

Postterm pregnancy refers to a pregnancy that has reached or extended beyond 42 0/7 weeks of gestation from the last menstrual period (LMP), whereas a late-term pregnancy is defined as one that has reached between 41 0/7 weeks and 41 6/7 weeks of gestation.

Perinatal mortality increases as pregnancy extends beyond full term, particularly after 41 weeks, due to increases in both nonanomalous stillbirths and early neonatal deaths. Intervention at 41 0/7 weeks reduces perinatal mortality without increasing perinatal morbidity or cesarean delivery rates.

Accurate determination of gestational age is essential to accurate diagnosis and appropriate management of late-term and postterm pregnancies. (See EDD Assignment and Management of Suboptimally Dated Pregnancy).

For patients with accurate dating: 

  • During the 39th week, begin weekly cervical exams with membrane stripping if GBS negative.  Document in the obstetric record, if membranes are striped.  Review fetal kick count protocol with patient (ten movements in two hours daily).
  • During the 40th week, discuss management options, if labor fails to ensue.
  • At the beginning of the 41st week, admit patient to hospital for labor induction with cervical ripening if indicated.
  • If the patient desires continued expectant management, begin twice-weekly antenatal testing with a goal for delivery as soon as the patient is willing.

 
For patient with suboptimal dating:  

  • During the 39th week, begin weekly cervical exams with membrane stripping if GBS negative.  Document in the obstetric record, if membranes are striped.  Review fetal kick count protocol with patient (ten movements in two hours daily).
  • During the 40th week, begin twice-weekly antepartum fetal surveillance.
  • At the beginning of the 41st week, admit patient to hospital for labor induction with cervical ripening if indicated.
  • If the patient desires continued expectant management, continue twice-weekly antenatal testing with a goal for delivery as soon as the patient is willing.

References

  1. Management of late-term and postterm pregnancies. Practice Bulletin No. 146. American College of Obstetricians and Gynecologists. August 2014.
  2. Management of Suboptimally Dated Pregnancies. Committee Opinion No. 688. American College of Obstetricians and Gynecologists. March 2017.

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