TITLE: Management of postterm pregnancy.

 

SOURCE(S): Washington (DC): American College of Obstetricians and Gynecologists; 1997 Oct. 6 p. (ACOG practice patterns; no. 6). [21 references]

 

ADAPTATION: Not applicable: Guideline was not adapted from another source.

 

RELEASE DATE: 1997 Oct

 

MAJOR RECOMMENDATIONS:

 

Levels of evidence (I-III) and strengths of recommendations (A-C) are defined at the end of the Major Recommendations field.

 

Evaluation of Postterm Patient

 

• Antenatal surveillance of postterm pregnancies should be initiated by 42 weeks of gestation despite a lack of evidence that monitoring improves outcomes (C: III).
• There is insufficient evidence that initiating antenatal surveillance between 40-42 completed weeks of gestation improves outcomes.
• No single antenatal surveillance protocol for monitoring fetal well-being in postterm pregnancy appears superior to another.

 

Managing a Postterm Pregnancy

 

• It is unknown whether induction or expectant management is preferable to manage an otherwise uncomplicated postterm patient with a favorable cervix (A:I).
• There is good evidence that either induction or expectant management will result in good outcomes among postterm patients with favorable cervices and without additional complications (A:I).

 

Prostaglandin Gel

 

Prostaglandin gel can be used safely in postterm pregnancies to promote cervical changes and induce labor (A:I).

 

Cost-Effectiveness

 

There is mixed evidence regarding which strategy is more cost-effective. No recommendation can be made.

 

 

Definitions

Level of Evidence:

 

Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force:

 

I: Evidence obtained from at least one properly designed randomized controlled trial

 

II-1: Evidence obtained from well-designed controlled trials without randomization

 

II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group

 

II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments could also be regarded as this type of evidence.

 

III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

 

Strength of Recommendation:

 

Based on the highest level of evidence found in the data, the following recommendations are provided and graded according to the following categories:

 

A. There is good evidence to support the recommendation.

B. There is fair evidence to support the recommendation.

C. There is insufficient evidence to support the recommendation; however, the recommendation may be made on other grounds.

 

CLINICAL ALGORITHM(S): None provided

 

DEVELOPER(S): American College of Obstetricians and Gynecologists - Medical Specialty Society

 

COMMITTEE: Committee on Practice Patterns

 

GROUP COMPOSITION:

American College of Obstetricians and Gynecologists (ACOG) Fellows, practicing obstetrician-gynecologists with specialties pertinent to the topic

 

ENDORSER(S): Not stated

 

GUIDELINE STATUS: This is the current release of the guideline. An update is not in progress at this time.