Induction of labor in the postdate fetus

Once a decision to induce a postdate pregnancy is reached, the likelihood of achieving a vaginal delivery can be predicted by the Bishop or pelvic score and the willingness or lack thereof to commit to sequential inductions. Cesarean delivery rates will be significantly increased if an amniotomy is performed in the woman with an unfavorable cervix. Accordingly, we advocate sequential induction of the postdate pregnancy in the absence of other maternal or fetal mandates for imminent delivery. A host of oxytocin induction protocols exist and are acceptable, as are guidelines for what constitutes an adequate labor pattern. Although an increasing number of agents are available for cervical ripening, for the foreseeable future dilute intravenous oxytocin will remain the labor induction agent of choice.