The mother who is overdue[md]postmaturity

Babies who are more than two weeks postmature are at increased risk of stillbirth, so it is the custom in much of the developed world to induce them, although there is no convincing evidence that this reduces the perinatal mortality. You will have to weigh up the risks. Induction may reduce the risk from postmaturity, but an induced labour is longer and more complicated than a spontaneous one, and has its own risks.

In the district hospitals of the developing world the risks of accidental premature induction are much greater than they are elsewhere because: (1) A mother's dates may be wrong, because she conceived while breast-feeding, or soon after stopping, before having had a period since her previous pregnancy. Breast-feeding also results in periods which are less frequent than normal. For example, if periods occur every two months, conception will occur 6 weeks after the last period, instead of 2 weeks. These errors are always such that pregnancy is less advanced than mothers think. (2) Many mothers present so late for their first antenatal visit, that the size of the uterus cannot be reliably used to confirm their dates. The risks of routinely inducing postmature mothers thus outweigh its benefits, so postmaturity is only a relative reason for induction. Ask concerned mothers to keep fetal movement charts (M 28.3).

POSTMATURITY. If a mother is more than 42 weeks, and her dates are certain, admit her and ask her to keep a fetal movements chart (M 28.3). If she has any of these risk factors, induce her with oxytocin and rupture her membranes: (1) She is a nullip over 30. (2) She is a multip over 40. This is unusual, so check her dates, and her baby's ''size for dates'. (3) She has a bad obstetric history. (4) She has gestational hypertension. (5) She has markedly reduced fetal movements. If induction is impossible or fails, section her.