Management of the postdates pregnancy

A. A postdates patient with a favorable cervix should receive induction of labor. Only 8.2% of pregnancies at 42 weeks have a ripe cervix (Bishop score >6). Induction at 41 weeks with cervical ripening lowers the cesarean delivery rate.

B. Placement of a balloon catheter immediately followed by vaginal or intracervical prostaglandin E2 administration is recommended. Oxytocin, if required, can be started six hours after the last prostaglandin dose.

C. Stripping of membranes, starting at 38 weeks and repeated weekly may be an effective method of inducing labor in post-term women with a favorable cervix. Stripping of membranes is performed by placing a finger in the cervical os and circling 3 times in the plane between the fetal head and cervix.

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