Skip to main content Accessibility help
Hostname: page-component-7479d7b7d-t6hkb Total loading time: 0 Render date: 2024-07-14T20:04:35.162Z Has data issue: false hasContentIssue false

Chapter 59 - Prolonged Pregnancy

from Section 6 - Late Prenatal – Obstetric Problems

Published online by Cambridge University Press:  15 November 2017

David James
University of Nottingham
Philip Steer
Imperial College London
Carl Weiner
University of Kansas
Bernard Gonik
Wayne State University, Detroit
Stephen Robson
University of Newcastle
Get access


Prolonged or post-term pregnancies are associated with an increased risk of perinatal mortality and morbidity when compared with pregnancies ending at term. This adverse outcome is mainly associated with placental insufficiency, meconium aspiration syndrome, macrosomia, and birth injury.

High-Risk Pregnancy
Management Options
, pp. 1696 - 1707
Publisher: Cambridge University Press
First published in: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Hilder, L, Costeloe, K, Thilaganathan, B. Prolonged pregnancy: evaluating gestation-specific risks of fetal and infant mortality. Br J Obstet Gynaecol 1998; 105: 169–73.Google Scholar
Divon, MY, Haglund, B, Nisell, H, et al. Fetal and neonatal mortality in the post-term pregnancy: the impact of gestational age and fetal growth restriction. Am J Obstet Gynecol 1998; 178: 726–31.CrossRefGoogle Scholar
Clausson, BM, Cnattingius, S, Axelsson, O. Outcomes of post-term births: the role of fetal growth restriction and malformations. Obstet Gynecol 1999; 94: 758–62.Google Scholar
Olesen, AW, Westergaard, JG, Olsen, J. Perinatal and maternal complications related to post-term delivery: a national register-based study, 1978–1993. Am J Obstet Gynecol 2003; 189: 222–7.CrossRefGoogle Scholar
Strobel, E, Sladkevicius, P, Rovas, L, et al. Bishop score and ultrasound assessment of the cervix for prediction of time to onset of labor and time to delivery in prolonged pregnancy. Ultrasound Obstet Gynecol 2006; 28: 298305.Google Scholar
Thliveris, JA, Baskett, TF. Fine structure of the human placenta in prolonged pregnancy. Preliminary report. Gynecol Obstet Invest 1978; 9: 40–8.Google Scholar
Vorherr, H. Placental insufficiency in relation to post-term pregnancy and fetal postmaturity. Evaluation of fetoplacental function; management of the post-term gravida. Am J Obstet Gynecol 1975; 123: 67103.CrossRefGoogle ScholarPubMed
World Health Organization. WHO: recommended definitions, terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths. Modifications recommended by FIGO as amended October 14, 1976. Acta Obstet Gynecol Scand 1977; 56: 247–53.Google Scholar
Burke, C, Morrison, JJ. Perinatal factors and preterm delivery in an Irish obstetric population. J Perinat Med 2000; 28: 4953.Google Scholar
Rush, RW, Keirse, MJ, Howat, P, et al. Contribution of preterm delivery to perinatal mortality. Br Med J 1976; 2: 965–8.Google Scholar
Bjerkedal, T, Bakketeig, LS. Medical Registration of Births in Norway during the 5-Year Period 1967–1971. Time Trends and Differences between Countries and between Municipalities. Bergen: Institute of Hygiene and Social Medicine, University of Bergen, 1975, p. 71.Google Scholar
Chamberlain, G, Phillip, E, Howlett, B, Masters, K. British births 1970. In Obstetric Care, vol. 2. London: Heinemann, 1978, p. 292.Google Scholar
Jolly, WA. On the period of human gestation. J Obstet Gynaecol Br Emp 1928; 35: 258–70.Google Scholar
Williams, JW (ed.). Obstetrics. New York: Appleton, 1923, pp. 223–4.Google Scholar
Geirsson, RT, Busby-Earle, RM. Certain dates may not provide a reliable estimate of gestational age. Br J Obstet Gynaecol 1991; 98: 108–9.Google Scholar
Nakling, J, Buhaug, H, Backe, B. The biologic error in gestational length related to the use of the first day of last menstrual period as a proxy for the start of pregnancy. Early Hum Dev 2005; 81: 833–9.CrossRefGoogle Scholar
Buekens, P, Delvoye, P, Wollast, E, Robyn, C. Epidemiology of pregnancies with unknown last menstrual period. J Epidemiol Community Health 1984; 38: 7980.Google Scholar
Taipale, P, Hiilesmaa, V. Predicting delivery date by ultrasound and last menstrual period in early gestation. Obstet Gynecol 2001; 97: 189–94.Google Scholar
Savitz, DA, Terry, JW, Dole, N, et al. Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. Am J Obstet Gynecol 2002; 187: 1660–6.Google Scholar
Gjessing, HK, Skjaerven, R, Wilcox, AJ. Errors in gestational age: evidence of bleeding early in pregnancy. Am J Public Health 1999; 89: 213–18.CrossRefGoogle ScholarPubMed
Hogberg, U. Early dating by ultrasound and perinatal outcome: a cohort study. Acta Obstet Gynecol Scand 1997; 76: 907–12.Google Scholar
Wilcox, M, Gardosi, J, Mongelli, M, et al. Birth weight from pregnancies dated by ultrasonography in a multicultural British population. BMJ 1993; 307: 588–91.Google Scholar
Neilson, JP. Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev 1998; (4): CD000182.Google Scholar
Kopta, MM, May, RR, Crane, JP. A comparison of the reliability of the estimated date of confinement predicted by crown–rump length and biparietal diameter. Am J Obstet Gynecol 1983; 145: 562–5.Google Scholar
Bukowski, R, Smith, GCS, Malone, FD, et al. Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study. BMJ 2007; 334: 836–7.CrossRefGoogle ScholarPubMed
Salomon, LJ, Nasr, B, Benoist, G, et al. Intra- and interobserver variability and reproducibility of biparietal diameter and crown rump length for ultrasound dating at 11–14 weeks of gestation. Ultrasound Obstet Gynecol 2007; 30: 544.CrossRefGoogle Scholar
Salomon, LJ, Bernard, M, Amarsy, R, Bernard, JP, Ville, Y. The impact of crown–rump length measurement error on combined Down syndrome screening: a simulation study. Ultrasound Obstet Gynecol 2009; 33: 506–11.Google Scholar
Naaktgeboren, N, Devroey, P, Wisanto, A, Traey, E, Van Steirteghem, AC. Endocrine profiles in early pregnancies with delayed implantation. Hum Reprod 1986; 1: 914.Google Scholar
Ahlborg, L, Ek, S, Fridström, M, et al. Is fetal growth impaired after in vitro fertilization? Acta Obstet Gynecol Scand. 2006; 85: 195–9.CrossRefGoogle ScholarPubMed
Gjerris, AC, Loft, A, Pinborg, A, Tabor, A, Christiansen, M. First-trimester screening in pregnancies conceived by assisted reproductive technology: significance of gestational dating by oocyte retrieval or sonographic measurement of crown–rump length. Ultrasound Obstet Gynecol 2008; 32: 612–17.Google Scholar
Chitty, L, Evans, T, Chudleigh, P. Fetal size and dating: charts recommended for clinical obstetric practice. London: British Medical Ultrasound Society, 2007.Google Scholar
National Institute for Health and Care Excellence. Antenatal Care for Uncomplicated Pregnancies. NICE Clinical Guideline CG62. London: NICE, 2008. (accessed March 2017).Google Scholar
Salomon, LJ, Alfirevic, Z, Bilardo, CM, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2013; 41: 102–13.Google Scholar
Rahim, RR, Cuckle, HS, Sehmi, IK, Jones, RG. Compromise ultrasound dating policy in maternal serum screening for Down syndrome. Prenat Diagn 2002; 22: 1181–4.CrossRefGoogle ScholarPubMed
Wald, NJ, Cuckle, HS, Densem, JW, Kennard, A, Smith, D. Maternal serum screening for Down’s syndrome: the effect of routine ultrasound scan determination of gestational age and adjustment for maternal weight. Br J Obstet Gynaecol 1992; 99: 144–9.Google Scholar
Benn, PA, Borgida, A, Horne, D, et al. Down syndrome and neural tube defect screening: the value of using gestational age by ultrasonography. Am J Obstet Gynecol 1997; 176: 1056–61.Google Scholar
Patel, RR, Steer, P, Doyle, P, et al. Does gestation vary by ethnic group? A London-based study of over 122,000 pregnancies with spontaneous onset of labour. Int J Epidemiol 2004; 33: 107–13.Google Scholar
Aveyard, P, Cheng, KK, Manaseki, S, Gardosi, J. The risk of preterm delivery in women from different ethnic groups. BJOG 2002; 109: 894–9.Google Scholar
Omigbodun, AO, Adewuyi, A. Duration of human singleton pregnancies in Ibadan, Nigeria. J Natl Med Assoc 1997; 89: 617–21.Google ScholarPubMed
Onah, HE. Effect of prolongation of pregnancy on perinatal mortality. Int J Gynecol Obstet 2003; 80: 255–61.Google Scholar
York, TP, Eaves, LJ, Neale, MC, Strauss, JF. The contribution of genetic and environmental factors to the duration of pregnancy. Am J Obstet Gynecol 2014; 210: 398405.CrossRefGoogle Scholar
Laursen, MM. Genetic influence of prolonged gestation: a population-based Danish twin study. Am J Obstet Gynecol 2004; 190: 489–94.CrossRefGoogle ScholarPubMed
Oleson, AW, Basso, O, Olsen, J. Risk of recurrence of prolonged pregnancy. BMJ 2003; 326: 476.CrossRefGoogle Scholar
Honnebier, WJ, Swaab, DF. The influence of anencephaly upon intrauterine growth of fetus and placenta and upon gestation length. J Obstet Gynaecol Br Commonw 1973; 80: 577–88.Google Scholar
McLean, M, Bisits, A, Davies, J. et al. A placental clock controlling the length of human pregnancy. Nat Med 1995; 1: 460–3.Google Scholar
Romero, R, Espinoza, J, Mazor, M, Chaiworapongsa, T. The preterm parturition syndrome. In Critchley, H, Bennett, P, Thornton, S (eds), Preterm Birth. London: RCOG Press, 2004, pp. 2860.Google Scholar
Smith, R, Paul, H, Maiti, K, Tolosa, J, Madsen, G. Recent advances in understanding the endocrinology of human birth. Trends Endocrinol Metab 2012; 23: 516–23.Google Scholar
Tunon, K, Eik-Nes, SH, Grottum, P. A comparison between ultrasound and a reliable last menstrual period as predictors of the day of delivery in 15,000 examinations. Ultrasound Obstet Gynecol 1996; 8: 178–85.Google Scholar
Balchin, I, Whittaker, JC, Steer, PJ, Lamont, RF. Timing of planned cesarean delivery by racial group. Obstet Gynecol 2008; 111: 659–66.Google Scholar
Balchin, I, Whittaker, JC, Steer, PJ, Lamont, RF. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011; 117: 828–35.Google Scholar
Mathai, M, Thomas, S, Peedicayil, A, et al. Growth pattern of the Indian fetus. Int J Gynecol Obstet 1995; 48: 21–4.Google Scholar
Balchin, I, Whittaker, JC, Patel, R, et al. Racial variation in the relationship between gestational age and perinatal mortality: prospective study. BMJ 2007; 334: 833–5.Google Scholar
Balchin, I, Steer, P. Race, prematurity and immaturity. Early Hum Dev 2007; 83: 749–54.Google Scholar
Handa, VL, Lockhart, ME, Fielding, JR, et al. Racial differences in pelvic anatomy by magnetic resonance imaging. Obstet Gynecol 2008; 111: 914–20.Google Scholar
Baragi, RV, Delancey, JO, Caspari, R, Howard, DH, Ashton-Miller, JA. Differences in pelvic floor area between African American and European American women. Am J Obstet Gynecol 2002; 187: 111–15.Google Scholar
Dolea, C, AbouZahr, C. Global burden of obstructed labour in the year 2000. Geneva: World Health Organization, 2003. (accessed March 2017).Google Scholar
Blackburn, TM, Gaston, KJ, Loder, N. Geographic gradients in body size: a clarification of Bergmann’s rule. Divers Distrib 1999; 5: 165–74.Google Scholar
Olesen, AW, Westergaard, JS, Olsen, J. Prenatal risk indicators of a prolonged pregnancy. The Danish Birth Cohort 1998–2001. Acta Obstet Gynecol 2006; 85: 1338–41.Google Scholar
Zhou, XL. Clinical analysis of the relation between maternal body weight and high risk factors during pregnancy and delivery. Zhonghua Fu Chan Ke Za Zhi 1993; 28: 397–8.Google ScholarPubMed
Gülmezoglu, AM, Crowther, CA, Middleton, P. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2006; (4): CD004945.Google Scholar
Ayers, S, Collenette, A, Hollis, B, Manyonda, I. Feasibility study of a latest date of delivery (LDD) system of managing pregnancy. J Psychosom Obstet Gynaecol 2005; 26: 167–71.Google Scholar
Heimstad, R, Romundstad, PR, Hyett, J, et al. Women’s experiences and attitudes towards expectant management and induction of labour for post-term pregnancy. Acta Obstet Gynecol 2007; 86: 950–6.Google Scholar
Roberts, LJ, Young, KR. The management of prolonged pregnancy: an analysis of women’s attitudes before and after term. Br J Obstet Gynaecol 1991; 98: 1102–6.CrossRefGoogle ScholarPubMed
Sharma, JB, Smith, RJ, Wilkin, DJ. Induction of labour at term: women not for waiting. BMJ 1993; 306: 1413.Google Scholar
Rane, SM, Guirgis, RR, Higgins, B, Nicolaides, KH. Pre-induction sonographic measurement of cervical length in prolonged pregnancy: the effect of parity in the prediction of the need for cesarean section. Ultrasound Obstet Gynecol 2003; 22: 45–8.Google Scholar
Crowley, P. Post term pregnancy: induction or surveillance? In Chalmers, I, Enkins, M, Kierse, MJN (eds). Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1989, pp. 776–91.Google Scholar
Elliott, PM, Inman, WHW. Volume of liquor amnii in normal and abnormal pregnancy. Lancet 1961; ii: 835–40.Google Scholar
Shime, J. Influence of prolonged pregnancy on infant development. J Reprod Med 1988; 33: 277–84.Google Scholar
Olesen, A, Olsen, J, Zhu, J. Developmental milestones in children born post-term in the Danish National Birth Cohort: a main research article. BJOG 2015; 122: 1331–9.Google Scholar
Lindstrom, K, Fernell, E, Westgren, M. Developmental data in preschool children born after prolonged pregnancy. Acta Paediatr 2005; 94: 1192–7.Google Scholar
National Institute for Health and Care Excellence. Inducing Labour. NICE Clinical Guideline CG70. London: NICE, 2008. (accessed March 2017).Google Scholar
Heimstad, R, Romundstad, PR, Salvesen, KA Induction of labour for post-term pregnancy and risk estimates for intrauterine and perinatal death. Acta Obstet Gynecol Scand 2008; 87: 247–9.CrossRefGoogle ScholarPubMed
Heimstad, R, Skogvoll, E, Mattsson, LA, et al. Induction of labor or serial antenatal fetal monitoring in post-term pregnancy: a randomised controlled trial. Obstet Gynecol 2007; 109: 609–17.Google Scholar
Allott, HA, Palmer, CR. Sweeping the membranes: a valid procedure in stimulating the onset of labour? Br J Obstet Gynaecol 1993; 100: 898903.CrossRefGoogle ScholarPubMed
Foong, LC, Vanaja, K, Tan, G, Chua, S. Membrane sweeping in conjunction with labor induction. Obstet Gynecol 2000; 96: 539–42.Google Scholar
Boulvain, M, Stan, CM, Irion, O. Membrane sweeping for induction of labour. Cochrane Database Syst Rev 2005; (1): CD000451.Google Scholar
Hill, MJ, McWilliams, GD, Garcia-Sur, D, et al. The effect of membrane sweeping on prelabor rupture of membranes: a randomized controlled trial. Obstet Gynecol 2008; 111: 1313–19.Google Scholar
Grant, A, Elbourne, D, Valentin, L, Alexander, S. Routine formal movement counting and risk of antepartum late death in normally formed singletons. Lancet 1989; ii: 345–9.Google Scholar
Sande, JA, Ioannou, C, Sarris, I, Ohuma, EO, Papageorghiou, AT. Reproducibility of measuring amniotic fluid index and single deepest vertical pool throughout gestation. Prenat Diagn 2015; 35: 434–9.Google Scholar
Alfirevic, Z, Luckas, M, Walkinshaw, SA, McFarlane, M, Curran, R. A randomised comparison between amniotic fluid index and maximum pool depth in the monitoring of post-term pregnancy. Br J Obstet Gynaecol 1997; 104: 207–11Google Scholar
Morris, RK, Meller, CH, Tamblyn, J, et al. Association and prediction of amniotic fluid measurements for adverse pregnancy outcome: systematic review and meta-analysis. BJOG 2014; 121: 686–99.Google Scholar
Morris, JM, Thompson, K, Smithey, J, et al. The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective blinded observational study. BJOG 2003; 110: 989–94.Google Scholar
Dasari, P, Niveditta, G, Raghavan, S. The maximal vertical pocket and amniotic fluid index in predicting fetal distress in prolonged pregnancy. Int J Gynecol Obstet 2007; 96: 8993.Google Scholar
Alfiveric, Z, Walkinshaw, SA. A randomised controlled trial of simple compared with complex antenatal monitoring after 42 weeks of gestation. Br J Obstet Gynaecol 1995; 102: 638–43.Google Scholar
Cruz-Martinez, R, Figueras, F, Hernandez-Andrade, E, et al. Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses. Obstet Gynecol 2011; 117: 618–26.Google Scholar
D’Antonio, F, Patel, D, Chandrasekharan, N, Thilaganathan, B, Bhide, A. Role of cerebroplacental ratio for fetal assessment in prolonged pregnancy. Ultrasound Obstet Gynecol 2013; 42: 196200.Google Scholar
Hofmeyr, GJ, Xy, H, Eke, AC. Amnioinfusion for meconium-stained liquor in labour. Cochrane Database Syst Rev 2014; (1): CD000014.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats