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Nursing QUESTION #9140
Question 1
A primigravida at 41+3 weeks is admitted for post-term pregnancy management. Bishop score is 4. CTG is reactive. Amniotic fluid index (AFI) is 6 cm. What is the MOST appropriate next step?
  • Discharge home with daily kick counts only
  • Emergency cesarean section due to post-term status
  • Cervical ripening with prostaglandins followed by induction of laborāœ”ļø
  • Conservative management until 42 weeks with twice-weekly NST
Correct Answer Explanation

Post-term Pregnancy Management (\(\geq 42\) weeks; post-dates \(\geq 41\) weeks):

This patient:

  • 41+3 weeks = post-dates (risk period begins)
  • Bishop score 4 = unfavorable cervix (score \(\leq 6\))
  • AFI 6 cm = borderline oligohydramnios (normal: \(8{-}24\,\text{cm}\); oligohydramnios: \(\leq 5\,\text{cm}\))
  • Reactive CTG = reassuring currently

Risks of post-term pregnancy:

  • Placental insufficiency, meconium aspiration
  • Macrosomia, shoulder dystocia
  • Oligohydramnios, cord compression
  • Perinatal mortality increases after 41 weeks

Management: Most guidelines recommend induction of labor by 41ā€“42 weeks. With unfavorable cervix (Bishop score 4), cervical ripening first (Prostaglandin Eā‚‚ gel/insert or misoprostol) then oxytocin induction.

AFI trending down is additional reason not to wait further. Conservative management is inappropriate here.