Management of Pregnancy at 40 Weeks Gestation

Evidence for Induction at 40 Weeks

The American College of Obstetricians and Gynecologists recommends elective induction of labor at 39 weeks 0-4 days as a reasonable option for low-risk nulliparous women with reliable dating 1
Elective induction of labor at 39 weeks is associated with reduced cesarean delivery rates (18.6% vs 22.2%) compared to expectant management 1
Reduced incidence of hypertensive disorders of pregnancy (9.1% vs 14.1%) with elective induction compared to expectant management 1

For pregnancies with fetal growth restriction (FGR) and normal Doppler studies, delivery is recommended at 38-39 weeks gestation 2
For FGR with decreased diastolic flow, delivery is recommended at 37 weeks gestation 2
For women with cardiac disease, induction of labor at 40 weeks is recommended to avoid complications associated with prolonged pregnancy 3
In women at high risk for valve thrombosis requiring anticoagulation, planned delivery may be necessary to minimize the period off anticoagulation 4

Vaginal delivery is recommended for most women, with cesarean section reserved for obstetric indications 4
Epidural anesthesia is recommended to avoid the stress of pain during delivery 3
For high-risk patients with cardiac disease, elective cesarean section should be considered to maintain more stable hemodynamics 3

Confirm accurate dating of pregnancy before making decisions about induction 1
Discuss the benefits and risks of induction versus expectant management with the patient 1
If induction is chosen, use appropriate cervical ripening methods for unfavorable cervix 1
Allow adequate time for labor progress during the induction process 1
Monitor fetal well-being throughout labor with appropriate fetal surveillance 5