REVIEW
Prolonged pregnancy
Sara Latif
Catherine Aiken
Abstract
Pregnancy that continues beyond 42 weeks of gestation (post-term)
confers increased antepartum and intrapartum fetal risk. Maternal
risk may also be associated with post-term pregnancy, for example
via increased likelihood of delivery via emergency Caesarean section.
The increased likelihood of adverse perinatal outcomes associated
with post-term pregnancy derives mainly from increasing fetal size
and placental ageing. The key intervention currently available to
manage the risks associated with prolonged pregnancy is to offer de-
livery. In the UK, this is routinely offered from 41 weeks onwards, but
timing differs up to 42 weeks across global settings. Although offering
induction of labour to manage post-term pregnancy is routine and ap-
pears to minimize risk, women should feel supported by healthcare
professionals for women if they opt for expectant management or
decline induction of labour. Recent evidence suggests that elective in-
duction of labour beyond 39 weeks in otherwise low-risk pregnancies
is not associated with increased maternal or fetal risk, and may help to
avoid Caesarean section.
Keywords expectant management; induction of labour; post-matu-
rity; post-term; stillbirth
Terminology is important in obstetrics, in particular to achieve
shared understanding of the risk associated with pregnancy
complications. The terms ‘prolonged pregnancy’, ‘post-dates’,
and ‘post-term’ are often used interchangeably, although they
may also be understood to describe differing time-points. The
descriptor ‘post-term’ is the best defined, and is most widely used
for any pregnancy that has proceeded beyond 294 days of
gestation. This definition is recognized by the Royal College of
Obstetricians and Gynaecologists (RCOG), the American College
of Obstetricians, and Gynecologists (ACOG), the World Health
Organization (WHO), and the International Federation of Gyne-
cology and Obstetrics (FIGO).
The reported global frequency of post-term pregnancies is
between 5 and 15%. Describing this proportion of the population
as beyond the normal range is in keeping with the statistical
approach to defining thresholds for other obstetric risk factors,
such as small-for-gestational age fetuses. However, the reported
percentage of the population in whom pregnancy actually pro-
ceeds beyond 42 weeks varies widely in different clinical set-
tings, primarily as a result of differences in recommendations for
obstetric management of pregnancies in the 40e42 week range.
Sara Latif MRCOG Senior Clinical Fellow, The Rosie Hospital,
Cambridge, UK. Conflicts of interest: none declared.
Catherine Aiken PhD MRCOG University Lecturer and Honorary
Consultant in Maternal and Fetal Medicine, University Department of
Obstetrics and Gynaecology, University of Cambridge, Cambridge,
UK. Conflicts of interest: none declared.
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The incidence of prolonged pregnancy appears to be reducing
over time in well-resourced obstetric settings, as intervention to
deliver pregnancies that have proceeded beyond the due date is
increasingly recommended.
Aside from management recommendations, the other factor
that significantly influences the percentage of pregnancies clas-
sified as post-term is the accuracy of dating pregnancies. Routine
use of first trimester ultrasound tends to reduce the overall
incidence of post-term pregnancies compared to populations
where the due date is estimated from the last menstrual period.
Accurate determination of gestational age, ideally via measure-
ment of the crown-rump length between 10 and 13 weeks, is
essential to accurately identify pregnancies at risk of becoming
post-term and to allow timely initiation of appropriate manage-
ment discussions. Studies have suggested that a variety of
maternal factors increase the risk of post-term pregnancy
(Table 1), but many of these are not well-evidenced.
While it is widely accepted that post-term pregnancy is asso-
ciated with increased maternal and fetal risk compared to preg-
nancies that deliver prior to 42 weeks, there is considerable
heterogeneity regarding the magnitude of these risks in the
available literature. The risk of adverse perinatal outcomes in-
creases incrementally from w40 weeks onwards, rather than
with a step-change at 42 weeks, as the definition of post-term
pregnancy might imply. There are also potential risks associ-
ated with the management strategies to avoid post-term preg-
nancy (for example induction of labour). Hence individualized
counselling is essential to determine the optimal management for
each pregnancy, with appropriate consideration not only of the
risk arising from the duration of pregnancy but also the back-
ground risk conferred by factors such as parity and maternal age.
The specific risks associated with post-term pregnancy can be
divided into those that apply to the mother, to the fetus, and to
the neonate (Table 2).
Maternal risks associated with prolonged pregnancy
Simply by virtue of remaining pregnant longer, women with
post-term pregnancies are at higher risk of experiencing common
maternal complications of pregnancy, for example late-onset
hypertensive disorders of pregnancy and anaemia.
Studies also suggest that pregnancies continuing beyond
40 weeks are at addition risk of dysfunctional labour, including
delays in both the first and second stage. The aetiology of this
risk is likely to relate primarily to increased fetal size, in partic-
ular relative cephalo-pelvic disproportion, but may also reflect
issues with synchronous and effective myometrial contractility.
Cervical ripening and syncytial myometrial contractions are
essential for spontaneous delivery, and prolonged labour will
occur if these are not fully achieved. Hence if induction of labour
is undertaken in the context of post-term pregnancy, careful
active management is required to avoid further delays in
delivery.
If spontaneous delivery occurs, then the increased fetal size
associated with prolonged pregnancy confers a higher risk of
severe perineal trauma. Such trauma can include vaginal lacer-
ations leading to high blood loss and disruptions of the anal
sphincter complex. Meticulous attention to repair of these in-
juries is essential to optimize outcome, and hence it is important
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 REVIEW

Risk factors associated with post-term pregnancy

Risk factor Evidence/explanation

Dating Error C Naegle’s rule for estimating due date is error-prone due to assumptions about cycle length and regularity
C Dating using CRL reduces inductions for post term pregnancies
Nulliparity C Several studies suggest increased risk of post-term pregnancy in nulliparous women
C Possibly related to necessity to form de novo myometrial gap junctions ahead of first labour, but mechanism
poorly evidenced.
Previous Prolonged Pregnancy C Increased risk of prolonged pregnancy following previous post-term pregnancy.
C Mechanism not well-defined, but some evidence of transgenerational effect (daughters of mother with
prolonged pregnancies have higher risk)
Obesity C Recent studies suggest obesity is a risk factor for post-term pregnancy.
C Mechanism not well defined, but potentially modifiable risk factor.
Cephalopelvic Disproportion C Larger fetus is generally considered to be consequence of post-term pregnancy, but in some cases may also be
causal.
C Potential mechanisms include less lower uterine segment distenstion, reduced physical pressure on cervix, and
reduced prostaglandin production due to unengaged head
Fetal anomaly C Specific anomalies linked to post-term pregnancy include anencephaly, adrenal hypoplasia and placental
sulfatase deficiency
C Potentially due to lack of oestrogen in sufficiently high concentrations
Male Fetal Sex C Some evidence suggests increased risk of post-term induction of labour with a male fetus.

Table 1

the obstetrician recognizes post-term pregnancy as a risk factor increased vaginal trauma and blood loss. Emergency Caesarean
for perineal trauma. section is associated with increased maternal morbidity
Delay in the second stage is also more common in prolonged compared to other modes of delivery, including higher risks of
pregnancy, and is associated with complications such as blood loss, infection, and venous thromboembolism.
maternal pyrexia and post-partum haemorrhage. If spontaneous Pregnancies that continue to 42 weeks and beyond are also
delivery does not occur, then assisted vaginal delivery or emer- often accompanied by considerable maternal anxiety, for
gency Caesarean section must be performed. Assisted vaginal example about the reasons that labour has not yet started or
delivery is more likely to be unsuccessful in post-term pregnan- concerns for the well-being of the baby. Many mothers also ex-
cies, because of larger fetal size, and may also be associated with press feelings of frustration with waiting. These are important
psychological aspects of the pregnancy experience that are often
over-looked by healthcare professionals, and must be weighed
Complications of post-term pregnancy carefully when an individualized plan for management of post-
term pregnancy is made.
Maternal risks
C Dysfunctional labour
Fetal risks associated with prolonged pregnancy
C Perineal trauma including injuries to anal sphincter complex
C Emergency Caesarean section and instrumental deliveries Fetal complications associated with post-term pregnancy are
C Post-partum haemorrhage related to both increased fetal size and an increased likelihood of
C Pyrexia in labour placental dysfunction that accompanies placental ageing.
C Psychological morbidity Increased fetal size is a complicating factor that can both
Fetal Risks prolong labour and complicate delivery itself. Rates of macro-
C Macrosomia (shoulder dystocia; orthopaedic and neurologic somia are increased w2 fold in post-term babies, with associated
injury) increased rates of shoulder dystocia and birth trauma. After
C Oligohydramnios resulting in cord compression 40 weeks, babies are more likely to be born with low Apgar
C Hypoxic ischemic encephalopathy scores, and the risk of hypoxic ischaemic encephalopathy in-
C Stillbirth creases by 20% with every week after the estimated due date.
Neonatal Risks Placental ageing leading to post maturity syndrome is thought
C Low Apgar score to be due to reduced placental capacity and increased fetal de-
C Meconium Aspiration Syndrome mands. Compensatory redistribution of fetal renal blood flow to
C Acidaemia the brain may result in renal hypoperfusion and consequent
C Unexpected admission to neonatal intensive care unit oligohydramnios. Likewise oligohydramnios brings about cord
C Neonatal encephalopathy compression together with abnormal fetal heart rate patterns
thus necessitating continuous FHR monitoring intrapartum.
Table 2

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 REVIEW
The risk of antenatal stillbirth is the most commonly cited
reason to recommend delivery in a post-term pregnancy. Despite
a low absolute risk, the relative risk of antepartum stillbirth in-
creases steadily up to 42 weeks of gestation. Beyond 42 weeks,
there are few high quality epidemiological studies from which to
calculate the ongoing risk of expectant management, however
based on available evidence this is likely to continue to rise. The
likely aetiology of the increase in antenatal stillbirth is the
increasing likelihood of placental dysfunction as pregnancies
continue beyond the estimated date of delivery. In addition to
antepartum stillbirth, placental dysfunction in post-term preg-
nancies is associated with late-onset fetal growth restriction and
perinatal death.
Neonatal risks associated with prolonged pregnancy
Neonatal complications associated with post-term pregnancy
include unplanned admission to the neonatal intensive care unit
and acidaemia at delivery. Some evidence suggests that rates of
sudden infant death syndrome are higher in babies born beyond
42 weeks of pregnancy.
Babies that remain in utero at 41e42 weeks are also signifi-
cantly more likely to have passed meconium by the time labour
begins and thus have higher rates of meconium aspiration. The
finding of meconium in post-term labour can be normal and not
an indicator of fetal distress, but the presence of meconium-
stained liquor makes reassurance about fetal well-being more
difficult.
‘Post-maturity’ is a complication of post-term pregnancy, and
is not applicable to all babies born beyond 42 weeks of gestation.
It is used to describe babies born >42 weeks with distinctive
features such as dry skin, minimal subcutaneous fat deposition,
visible creases on palms and soles, or skin coloration from
meconium staining. These features are variously explained by
the loss of vernix or by placental dysfunction. Post-maturity
syndrome complicates up to 20% of post-term pregnancies.
Management of post-term pregnancies
In view of the continuous spectrum of increasing risk of both
antepartum stillbirth and intrapartum complications beyond 39
e40 weeks, there is significant debate about the optimal man-
agement of pregnancies that remain undelivered beyond the
estimated date of delivery. UK national guidelines suggest of-
fering delivery by induction of labour between 41 and 42 weeks
to avoid the risks of prolonged pregnancy. In other countries
around the world, delivery is routinely offered at various times
between 40 and 42 weeks. The WHO organization recommends
routine offer of induction of labour at 42 weeks, noting that both
expectant management and planned delivery carry risks to
mother and baby.
Observational studies examining expectant management
versus induction of labour often conclude that induction of la-
bour is associated with an increase in adverse outcomes, for
example increased rates of instrumental delivery. However
interpretation of such studies is complicated by unobserved
variation in the complexity of patients allocated to each group on
clinical grounds, with higher risk cases usually assigned to in-
duction. More recent evidence on this very important question
comes from several large randomized controlled trials, which
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avoid the difficulties inherent in clinical assignment of treatment
group. The 35/39 trial showed that induction of labour versus
expectant management in women over the age of 35 did not
result in additional morbidity for mother or baby. The ARRIVE
trial showed a reduction in the rate of Caesarean delivery in low-
risk women assigned to elective induction of labour at 39 weeks,
with 28 inductions needed to prevent 1 primary Caesarean sec-
tion. Moreover there was no increase in the rate of adverse
perinatal or delivery outcomes in the induction of labour group,
and a decrease in maternal hypertensive disorders. On the basis
of this trial, ACOG now endorses elective induction at 39 weeks
as a reasonable option to be offered to all women in the absence
of other risk factors. A further recent multicentre non-inferiority
trial in the Netherlands specifically examined the question of
inducing labour at 41 weeks versus expectant management. This
study concluded that induction reduced adverse perinatal out-
comes with no increase in maternal or fetal risks compared to
expectant management, although both strategies carried low
absolute risk in an otherwise healthy population. The SWEPIS
trial (a multi-centre, randomized, superiority trial conducted in
Sweden) was halted early due to a significantly higher rate of
perinatal mortality in pregnancies randomized to expectant
management until 42 weeks. There was no difference in adverse
maternal outcome between the group randomized to induction at
41 weeks versus expectant management until 42 weeks. These
valuable new sources of evidence should inform our manage-
ment of pregnancies that remain undelivered beyond the esti-
mated due date, and increase our confidence in recommending
induction of labour to avoid adverse perinatal outcomes.
Routinely offering mothers the option of delivery to avoid
post-term pregnancy leads to the question of whether induction
of labour, elective Caesarean section, or either should be offered.
As induction of labour at gestations beyond 39 weeks does not
appear to lead to an increased risk of emergency Caesarean
section, for low-risk women induction of labour would appear to
be the choice associated with the lowest risk of adverse out-
comes. However, other factors, such as previous mode of de-
livery, may tip the balance in favour of Caesarean delivery. In
other cases women may choose to accept the offer of delivery to
avoid the risks associated with post-term pregnancy, but refuse
induction of labour. In this case, the best available evidence
suggests that elective Caesarean section should be offered to
minimize perinatal risk. There is no high quality evidence
available to suggest that elective Caesarean section carries
additional morbidity when performed at 42 weeks or beyond
compared to 37e42 weeks.
Expectant management of post-term pregnancy is not
routinely offered in the majority of obstetric settings, but may be
requested by women. In this scenario, careful individualized
understanding of risk factors and counselling is the key to shared
decision-making. It is important that respect for the autonomy of
every individual to take decisions for themselves and their baby
is kept paramount, while ensuring that they have as much in-
formation as they desire on which to base their decisions. In the
UK, guidelines recommend that women who decline induction of
labour beyond 42 weeks should be offered monitoring with CTG
(minimum twice weekly, but often in practice performed more
often) and ultrasound scans to assess the liquor volume.
Observational studies suggest that the decline in liquor volume
172 Ó 2021 Elsevier Ltd. All rights reserved.
 REVIEW
observed from w35 weeks to 40 weeks is physiological, but it is
less clear whether the higher rates of oligohydramnios observed
after 40 weeks are associated with increased fetal risk. It has
been suggested that liquor volume may decline after 40 weeks
because of redistribution of fluid towards the fetal circulation,
but this is not supported by high-quality evidence. Women are
also routinely offered Doppler ultrasound estimations of the
umbilical artery pulsatility index and are advised to be aware of
fetal movements. However women choosing to await sponta-
neous labour should be informed of the limitations of fetal sur-
veillance, in particular the lack of any high quality evidence
suggesting that the surveillance currently available can prevent
adverse outcomes.
For labour in the context of post-term pregnancy, whether
induced or spontaneous, intra-partum care should be adapted to
minimize the associated risks. Continuous electronic fetal
monitoring is usually advised, despite its known limitations.
During labour, there are more likely to be concerns regarding
the fetal heart rate, which can lead to increased concerns about
fetal distress and higher rates of interventions. Due to
increasing maturity of the autonomic nervous system, the
baseline fetal heart rate tends be lower in post-term pregnancy.
Mild oligohydramnios is also a common finding in post-term
pregnancy, and the reduced liquor volume increases the risk
of variable decelerations due to cord compression. These fea-
tures can be difficult to distinguish from evidence of fetal
hypoxia when interpreting CTG tracings. With this in mind,
some women, particularly those who have chosen to wait for
spontaneous labour, may decline continuous fetal monitoring
post-term.
Counselling women on the management of post-term pregnancy
Strategy Risks
Expectant Management C Antepartum stillbirth
C Does not reduce rate of assisted or oper-
ative delivery
C Limitations of fetal surveillance
Membrane sweeping C Low quality evidence to suggest benefit
C May be uncomfortable
Induction of labour C Increased length of stay in hospital
C Precludes use of birth centre/pool
Planned Caesarean Section C Infection
C Bleeding
C VTE
C Placental morbidity in future pregnancies
C Visceral injury
Table 3
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Post-term labour is also associated with longer duration of
both the first and second stage, and thus close attention should
be paid to maternal pain relief, hydration, and rest. As with all
labouring women, there should be extensive support to ensure
comfort and mobility, with prompt response to requests for
analgesia or additional support. IV access may be considered,
given that the risk of post-partum haemorrhage is increased by
both higher birthweight and prolonged labour.
Counselling in the context of post-term pregnancy
Women must be given adequate time and counselling to come to
a decision about the management of their pregnancy, with the
discussion covering the major risks and benefits of each possible
strategy (Table 3). Regardless of the decision that a woman
comes to regarding management of her post-term pregnancy, she
should be supported in her decision. It is common for women to
feel ‘not listened to’ when their preferences diverge from the
recommendations of their care-givers or when their personal
decisions do not align with evidence regarding risk.
All conversations regarding management of prolonged preg-
nancy should begin by eliciting the ideas, concerns, and expec-
tations of the pregnant woman. She should be encouraged to
express both her preferences and her feelings about alternative
courses of action. Although informed decision-making involves
explaining the increased fetal and maternal risks associated with
prolonging pregnancy beyond 42 weeks, caregivers should be
aware that while the relative risks are increased, the absolute
risks remain low. It is therefore important to avoid being alarmist
in explanations about risk.
Benefits
C Absolute risk of adverse outcome post-
term is low
C Meeting maternal expectations
C Low risk intervention
C May reduce interval to spontaneous
delivery
C Acceptable to most women
C Reduced risk of adverse perinatal out-
comes (including stillbirth)
C Reduced risk of emergency Caesarean
section
C Reduced risk of maternal hypertensive
disorders
C No increased risk of maternal or fetal
morbidity associated with procedure
C Reduced risk of adverse perinatal out-
comes (including stillbirth)
C Reasonable option if associated risk fac-
tors (maternal age, previous Caesarean) or
declining induction of labour
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 REVIEW

While many women are frustrated by a post-term pregnancy and likely to result in decreased rather than increased health
and are happy to accept delivery, there are also many women service use.
whose strong preference is to avoid any intervention, including
induction of labour. In this case, it is important to explore a Conclusions
shared understanding of what induction of labour actually in-
Post-term pregnancy carries additional antepartum and intra-
volves and the associated risks. Women may perceive any
partum risk to both mothers and babies. These additional risks
intervention as adding potential risk for themselves or their baby,
are conferred mainly by increased fetal growth coupled with
and may be surprised by recent evidence that induction after
advanced placental ageing. Although the relative risk of adverse
39 weeks confers lower risk of Caesarean section than expectant
perinatal outcome is increased in post-term pregnancy, the
management. It may also be useful to explore perspectives of
additional absolute risk is low. Delivery is recommended to
other people whose opinions may strongly influence the
reduce the risk of antepartum stillbirth, although international
decision-making process, for example partners, although the
guidelines vary about when induction of labour should be
final decision regarding care must always rest with the mother
routinely offered in low-risk women. Women can be reassured
herself.
that recent evidence implies that induction of labour versus
For women who prefer not to have intervention in the context
expectant management after 39 weeks does not confer increased
of post-term pregnancy, it may be helpful to explore what they
risk of adverse perinatal outcomes, and may reduce the risk of
would feel able to accept, rather than to focus on what is
delivery by Caesarean section. Women who decline delivery in
declined. This may include agreeing on a point at which delivery
the context of post-term pregnancy should be offered information
would be acceptable if spontaneous labour did not occur. This
about risk, but supported in their decision-making. They should
focus can often bring into perspective the increased time at risk
be offered antenatal monitoring until delivery occurs, but with
of adverse antenatal outcomes, and be reassuring to both women
the caveat that monitoring has not been shown to prevent
and their caregivers. Women may also decline induction of la-
adverse outcomes in this context. A
bour, but be open to discussion of Caesarean section or less
invasive options such as membrane sweeping. A recent Cochrane
review concluded that membrane sweeping may be effective in FURTHER READING
inducing spontaneous labour and avoiding induction, although Induction of labour at 41 weeks versus expectant management and
the evidence in general regarding this is of low quality. Never- induction of labour at 42 weeks (Swedish Post-term Induction
theless it is a low risk intervention that may be offered in order to Study, SWEPIS): multicentre, open label, randomised, superiority
reduce the interval to spontaneous onset of labour, and which is trial. BMJ 2019 Nov 20; 367: l6131. https://doi.org/10.1136/bmj.
acceptable to many women. l6131.
Induction of labour for improving birth outcomes for women at or
Neonatal considerations beyond term. Cochrane Database Syst Rev 2018 May 9; 5:
CD004945.
Although the risks of unplanned admission to the neonatal
Labor induction versus expectant management in low-risk nulliparous
intensive care unit are increased, care of the baby born in good
women. N Engl J Med 2018 Aug 9; 379: 513e23. https://doi.org/10.
condition beyond 42 weeks does not differ from other term ba-
1056/NEJMoa1800566.
bies. There is a 2-fold increased risk of macrosomia, which may
National Institute for Clinical Excellence. Clinical guideline CG70
require careful attention to early feeding and blood sugar levels.
‘Inducing labour’. 2008. Published: 23 July, www.nice.org.uk/
Babies with post-maturity syndrome should be treated on
guidance/cg70.
symptomatic grounds and do not necessarily require specific
Risks of stillbirth and neonatal death with advancing gestation at term:
treatment with respect to this.
a systematic review and meta-analysis of cohort studies of 15
million pregnancies. PloS Med 2019 Jul 2; 16: e1002838. https://
Economic considerations
doi.org/10.1371/journal.pmed.1002838. eCollection 2019 Jul.
A significant concern regarding elective induction of labour at
term is that it would be associated with escalating healthcare
costs, and be unsustainable for many healthcare services. How-
ever cost-effectiveness modelling based on the results of the Practice points
ARRIVE trial implies that while elective induction at 39 weeks C Prolonged pregnancy carries increased relative risk of adverse
would be associated with increased costs, it is cost-effective in outcomes, although absolute risks remain low.
terms of reducing complications for both mothers (particularly C Women should be offered supportive and clear counselling when
hypertensive disease) and babies (particularly stillbirth at term). considering whether to accept offers of delivery.
A further study based on a subset of the ARRIVE trial concluded C Evidence suggests that induction of labour at term is not asso-
that elective induction at 39 weeks is cost neutral because of the ciated with increased maternal or neonatal morbidity.
reduction in complications and prolonged admissions associated C Antenatal monitoring can be offered to women experiencing
with post-term pregnancy. Based on this modelling, it follows prolonged pregnancy, but there is no evidence that it reduces the
that induction of labour versus expectant management at later risk of adverse outcome.
gestational ages (41 weeks and beyond) would be cost-effective

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