A healthy 23-year-old G1P0 has had an uncomplicated pregnancy to date. She is disappointed because she is 41 weeks gestational age by good dates and a first-trimester ultrasound and wants to have her baby She feels like she has been pregnant forever and wants to have her baby now. The patient reports good fetal movement; she has been doing kick counts for the past several days and reports that the baby moves about eight times an hour on average. On physical exam, her cervix is firm, posterior, 50% effaced, and 1 cm dilated, and the vertex is at a -1 station. As her obstetrician, which of the following would you recommend to the patient?

Post-term or prolonged pregnancies are those pregnancies that have gone beyond 42 completed weeks of gestation. In general, obstetricians do not allow pregnancies to persist after 42 weeks because of the significantly increased incidence of perinatal morbidity and mortality. If a patient has a ripe cervix, it is reasonable to induce the patient at 41 weeks because the chance of having a successful vaginal delivery is very high. On the other hand, if the patient has an unripe cervix, it is generally recommended that she continue with the pregnancy. Alternatively, a patient can be induced at 41 weeks with an unripe cervix if cervical ripening agents are used. If a patient waits until 42 weeks and still has an unripe cervix, then admission with administration of cervical ripening agents prior to Pitocin induction is recommended to improve the likelihood of a successful vaginal delivery. The Bishop score is a way to determine the favorability of the cervix to induction. The elements of the Bishop score include effacement, dilation, station, consistency, and position of the cervix (see table). Induction to active labor is usually successful with a Bishop score of 9 or greater. In the scenario described here, the patient has a Bishop score of 4, which is unfavorable for induction. Therefore, expectant management is a reasonable management plan to try to give the cervix time to ripen to avoid a cesarean section. It is not recommended to perform an elective section without a trial of labor because of the risks of major surgery.Bishop ScoreDilationEffacementStationConsistencyPosition0Closed0-30%-3FirmPosterior11-2 cm40-50%-2MediumMid-position23-4 cm60-70%-1,0SoftAnterior3>=5 cm>=80%+1,+2--