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OB Guideline 22: Prolonged Pregnancy

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OB Guideline 22: Prolonged Pregnancy

Related to: Communication, Cures Act: Opening Notes, Informed Consent, Obstetrics

Many descriptive labels are applied to pregnancies that go beyond the expected date of delivery (EDD). CRICO Guidelines supports ACOG’s classifications.1

Late-term: 410/7 weeks of gestation through 416/7 weeks of gestation.

Post-term: 420/7 weeks of gestation and beyond.

Post-term pregnancies are at risk for adverse outcomes that include an increased incidence of perinatal and neonatal morbidity and mortality, uteroplacental insufficiency, meconium aspiration, macrosomia, and intrauterine infection. Late-term pregnancies may also be at risk for an increased incidence of perinatal and neonatal morbidity. Accurate assessment of gestational age is of paramount importance for management of pregnancy, interpretation of test results, and timing of interventions. (see Guideline 7.)

Risks of Induction vs. Expectant Management

Clinicians should be familiar with the acceptable alternative methods of management of late-term and post-term pregnancies. Whichever method is chosen, the prenatal record must indicate that a discussion regarding management of pregnancy exceeding 41 weeks gestation occurred between the obstetrical provider and the patient.

The risks of induction include: failed induction, possibly leading to a cesarean delivery, and complications related to the use of oxytocin or prostaglandin administration, such as uterine tachysytole (hyperstimulation) and fetal intolerance of contractions.2 The risks of continued expectant management include but are not limited to: intrauterine fetal demise, perinatal death, meconium aspiration syndrome, and dysmaturity syndrome. Maternal risks include increased frequency of severe perineal lacerations, cesarean delivery, infection, and post-partum hemorrhage.3.

Management of Late-Term Pregnancy

CRICO recommends the following approach to managing pregnancies that go beyond the completion of the 41st gestational week. If the cervix is:

  1. favorable for oxytocin induction (patient is nullipara or multipara), then induction is preferred; fetal surveillance is an acceptable alternative;
  2. not favorable for oxytocin induction and the patient is multipara, then induction or fetal surveillance are acceptable alternatives; or
  3. not favorable for oxytocin induction and the patient is nullipara, then induction or fetal surveillance are acceptable alternatives.

If fetal surveillance is chosen, then twice-weekly fetal testing should begin by 7–9 days after the EDD. This should include an ultrasonographic assessment of amniotic fluid volume to detect oligohydramnios.

Management of Post-Term Pregnancy

Steps should be initiated to obtain consent and proceed to deliver the patient by induction or cesarean delivery as soon as is feasible.


  1. Definition of term pregnancy. ACOG Committee Opinion No. 579. November 2013, Reaffirmed 2015. American College of Obstetricians and Gynecologists.
  2. Induction of labor. ACOG Practice Bulletin No. 107. August 2009, Reaffirmed 2016. American College of Obstetricians and Gynecologists.
  3. Management of late-term and post-term pregnancies. ACOG Practice Bulletin No. 146. August 2014, Reaffirmed 2016. American College of Obstetricians and Gynecologists.
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January 8, 2018
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