Management of pregnancies beyond forty-one weeks' gestation with an unfavorable cervix.
OBJECTIVE
Our purpose was to determine the optimal management of pregnancies beyond 41 weeks' gestation with a cervix unfavorable for induction.


METHODS
All uncomplicated pregnancies that reached 41 weeks' gestation with a Bishop score of < or = 4 were randomly assigned to one of three groups: (1) daily cervical examinations, (2) daily membrane stripping, or (3) daily placement of prostaglandin gel until 42 weeks.


RESULTS
In 105 pregnancies the Bishop score on admission to labor and delivery was significantly greater in the groups receiving prostaglandin or stripping of the membranes versus the control group, whereas the converse was time of gestational age at delivery (p = 0.0001). Fewer patients required induction in the two treatment groups (20%, 17%) versus the control (69%) patients (p < 0.0001).


CONCLUSIONS
Daily membrane stripping or daily placement of prostaglandin gel is successful in reducing the number of inductions at 42 weeks for postdatism.
Magann
E F
EF
Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, California, USA.
Chauhan
S P
SP
Nevils
B G
BG
McNamara
M F
MF
Kinsella
M J
MJ
Morrison
J C
JC
D000282:Administration, Intravaginal; D000328:Adult; D002584:Cervix Uteri / Q000503:physiopathology*; D036861:Delivery, Obstetric / Q000379:methods; D015232:Dinoprostone / Q000008:administration & dosage / Q000627:therapeutic use; D005321:Extraembryonic Membranes; D005260:Female; D005782:Gels; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000379:methods; D010808:Physical Examination; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000502:physiology*; D011295:Prenatal Care; D011446:Prospective Studies; D013997:Time Factors
D005782:Gels; D015232:Dinoprostone