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Small-for-gestational-age babies after 37 weeks: impact study of risk-stratification protocol.
M Veglia1,2, A Cavallaro1,3, A Papageorghiou1
1Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Summary
A new risk-stratification protocol for small-for-gestational-age (SGA) fetuses improved perinatal outcomes. Expectant management for low-risk SGA babies beyond 37 weeks reduced adverse neonatal outcomes and hospital admissions.
Area of Science:
- Perinatal Medicine
- Maternal-Fetal Medicine
- Neonatal Outcomes
Background:
- International guidelines often recommend early-term delivery for small-for-gestational-age (SGA) fetuses, despite limited evidence.
- The optimal management strategy for SGA fetuses remains a subject of debate, impacting perinatal and maternal outcomes.
Purpose of the Study:
- To evaluate the impact of a risk-stratification protocol for SGA fetuses on perinatal and maternal outcomes.
- To determine if expectant management of low-risk SGA fetuses beyond 37 weeks improves outcomes compared to early delivery.
Main Methods:
- An impact study analyzed data from a tertiary referral unit over 39 months (January 2013 - April 2016).
- Included were singleton, non-anomalous fetuses diagnosed antenatally as SGA (estimated fetal weight < 10th centile) from 36+0 weeks.
- A risk-stratification protocol with expectant management for low-risk SGA babies after 37 weeks was compared to the previous strategy of delivery around 37 weeks.
Main Results:
- The protocol group (n=143) had a significantly lower incidence of neonatal composite adverse outcome (9% vs. 22%) and neonatal unit admission (13% vs. 39%) compared to the pre-protocol group (n=138).
- Mean gestational age at delivery was higher in the protocol group (38.2 weeks vs. 37.4 weeks).
- The protocol group showed lower rates of labor induction and Cesarean section, and a higher rate of vaginal delivery (83% vs. 60%).
Conclusions:
- Protocol-based management of SGA babies, including risk stratification and selective expectant management, appears to improve perinatal outcomes.
- Identification of moderate SGA alone should not be the sole indication for delivery.
- Larger studies are needed to assess the impact on perinatal mortality.
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