Postdates+Pregnancy

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** CCRMC OBGYN **** Prenatal Guideline ** Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours. Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.


 * Postdates Pregnancy**

Uncomplicated, low risk pregnancies are induced in the 41st week by calling the Perinatal Unit (Labor and Delivery) at 925-370-5608 and speaking to one of the nurses. Induction within the 41st week preferred between 41w0d-41w6d have lower section rate, better outcomes than continued expectant management beyond 42 weeks. The patient will be instructed to call Labor and Delivery on the planned date at either 8am or 10am to discuss arrival time depending on acuity on the unit. She should eat and drink normally that day. It is rare, but not impossible to be postponed to the next day. An instruction form is available in the prenatal forms section or on the star icon.

__**Remember:**__
 * Good dating prevents unnecessary postdates inductions--utilize early sono dating clinics, NT ultrasound or early formal ultrasound
 * Consider membrane sweeping beginning after 39wks
 * Only follow expectently into the 41 week uncomplicated pregnancies—pregnancies with HTN, DM, IUGR, twins, etc are all induced earlier
 * Let patients know early in the pregnancy that delivery in the week after the due date is normal and common.
 * Initiate antepartum testing with modified biweekly BPP ( NST, AFI) by 41 wks if induction is delayed beyond the first couple of days of the 41st week.


 * Previous Cesarean Delivery preferring VBAC:** Women with a prior cesarean section, **no prior vaginal delivery, and an unfavorable cervix** we recommend repeat cesarean due to success rate < 50% and slightly higher risk of uterine rupture. Consider delaying scheduled induction to latter part of 41st week to allow more time for spontaneous labor in this situation.

Discuss management of patients with uncertain dates with OB staff at the time of scheduling by requesting to speak to an OB Attending when you call to schedule.