Management of postterm pregnancies

The classic pregnancy term is between 37 and 42 weeks of gestation and the perinatal mortality and morbidity rates increasing progressively during this period, it is difficult to decide of an "ideal" term above which a medical intervention (induction of tabour) brings more benefits than risks linked to the natural evolution of pregnancy. There is a good scientific evidence for the induction of tabour from 41 weeks of gestation, defined like "postdating" term, when the cervical conditions are favourable (Bishop score > 5) and systematically from 42 weeks (significative reduction of perinatal mortality rate and not increased rate of cesarean delivery compared with expectant management). An intensive antenatal surveillance involving a nonstress test and an evaluation of amniotic fluid volume is an efficient alternative when the conditions of delivery are unfavourable between 41 and 42 weeks of gestation or when the woman does not wish induction. (C) 2007 Elsevier Masson SAS. Tous droits reserves.