Small for Gestational Age Babies After 37 Weeks: An Impact Study of a Risk Stratification Protocol.
Veglia M., Cavallaro A., Papageorghiou A., Black R., Impey L.
OBJECTIVES: Although no clear evidence exists, many international guidelines advocate early term delivery of small for gestational age (SGA) fetuses. The aim of this study was to determine whether a protocol that included monitoring SGA fetuses beyond 37 weeks affected perinatal and maternal outcomes. METHODS: The impact of the introduction in 2014 of a protocol for management of SGA, which included risk stratification with surveillance and expectant management after 37 weeks for lower risk babies (Group 2), was compared with the previous strategy, which recommended delivery at around 37 weeks (Group 1). Data from all referred SGA babies over a 39 month period were analyzed. RESULTS: In group 1 there were 138 SGA babies; in group 2 there were 143. The mean gestation at delivery was 37 + 4 and 38 + 2 weeks respectively (p = 0.04). The incidence of neonatal composite adverse outcomes was lower in Group 2 (9% v 22% v; p < 0.01) as was neonatal NNU admission (13% v 42%; p < 0.01). Induction of labour and caesarean section rates were lower, and vaginal delivery (83% v 60%; p < 0.01) was higher in group 2. Most of the differences were due to delayed delivery of SGA babies that were stratified as low risk. CONCLUSIONS: This study suggests that protocol-based management of SGA babies may improve outcomes and that identification of moderate SGA should not alone prompt delivery. Larger numbers are required to assess any impact on perinatal mortality.