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MIDWIFERY STRATEGIES FOR LIABILITY RISK REDUCTION POSTDATES PREGNANCY/POST MATURITY

Definition: A postdates pregnancy is one that continues beyond the completion of 42 weeks or 294 days of gestation (from the first day of the LMP), based on reliable dates. 

The etiology of postdates delivery is largely unknown. Predisposing factors may include anencephaly. The major complications for the postdates infant may include postmaturity syndrome, intrauterine growth restriction (IUGR), meconium aspiration, intrauterine hypoxia or asphyxia, fetal distress, fetal demise, oligohydramnios, macrosomia, and shoulder dystocia. The maternal complications may include increased incidence of dysfunctional labor, operative delivery, pelvic trauma, hemorrhage, and infection.

Antepartum Liability Risk Reduction Strategies:

• Performance and evaluation of a comprehensive history and physical examination with confirmation and documentation of estimated due date by 20 weeks gestation
• Utilization of appropriate laboratory studies and antepartum surveillance methodology
• Identification of risk by initial and interval assessments
• Counseling for individual risks
• Implementation and documentation of an individualized management plan regarding postdates pregnancy
• Involvement of patient and family members in decision-making
• Education regarding anticipated outcomes, benefits and risks of treatments, potential side effects and alternatives
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate

Intrapartum Liability Risk Reduction Strategies:

• Documentation of a comprehensive history and physical examination
• Identification of risk by initial and interval assessments
• Counseling and education regarding expectations and individual risks for postdates birth
• Assessment and documentation of gestational age, presentation and estimated fetal weight
• Utilization of appropriate laboratory and imaging studies and surveillance methodology
• Ongoing evaluation of labor pattern and fetal and maternal well-being
• Determination of location and route of birth based on assessment of maternal and infant morbidity and mortality risk
• Management of labor and birth in accordance with practice and/or institutional guidelines
• Education regarding anticipated outcomes, benefits and risks of treatments, potential side effects and alternatives
• Thorough documentation including the informed consent process
• Provision for immediately available maternal/neonatal resuscitation and life support
• Documentation of consultation, collaborative management, and/or referral as appropriate

Postpartum Liability Risk Reduction Strategies:

• Assessment of maternal and infant status
• Utilization of appropriate level of neonatal care
• Evaluation, management, and follow-up of complications
• Assistance with maternal efforts to establish and maintain lactation
• Facilitation of maternal/family attachment
• Documentation of education concerning needs and care of the mother and infant
• Education regarding benefits and risks of treatments, potential side effects and alternatives
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate

Source: ACNM DOSP Professional Liability Section
Approved: 1993
Revised: 12/03