ABSTRACT
PREGNANCY CONSIDERATIONS Every woman should be counseled early in pregnancy that up to 50% of gestations, especially in nulliparous women, last until past the due date. This is physiologic and natural for humans. The incidence of fetal death is significantly higher than that of neonatal death at 283 days (40 weeks and 3 days) (8). In large series, delivery at 38 weeks is associated with the lowest risk of perinatal death, but this risk is low at <1 to 2/1000 up to 41 weeks and 6 days (9). It is important to identify maternal (e.g., hypertension and diabetes) and fetal (e.g. growth restriction) risk factors that would necessitate special management, as described in the specific chapters in Maternal-Fetal Evidence Based Guidelines. The OR for stillbirths and neonatal mortality increases in gestations from 40 weeks onward, and this increase is compounded 7-to 10-fold when the fetus is growth restricted (10).
