Boers K E, van der Post J A M, Mol Ben W J, van Lith J M M, Scherjon S A
Department of Gynaecology and Obstetrics, Bronovo Hospital, Bronovolaan 5, 2597 AX The Hague, The Netherlands.
J Pregnancy. 2011;2011:293516. doi: 10.1155/2011/293516. Epub 2010 Dec 15.
Small for gestational age (SGA) is associated with increased neonatal morbidity and mortality. At present, evidence on whether these pregnancies should be managed expectantly or by induction is lacking. To get insight in current policy we analysed data of the National Dutch Perinatal Registry (PRN).
We used data of all nulliparae between 2000 and 2005 with a singleton in cephalic presentation beyond 36+0 weeks, with a birth weight below the 10th percentile. We analysed two groups of pregnancies: (I) with isolated SGA and (II) with both SGA and hypertensive disorders. Onset of labour was related to route of delivery and neonatal outcome.
Induction was associated with a higher risk of emergency caesarean section (CS), without improvement in neonatal outcome. For women with isolated SGA the relative risk of emergency CS after induction was 2.3 (95% Confidence Interval [CI] 2.1 to 2.5) and for women with both SGA and hypertensive disorders the relative risk was 2.7 (95% CI 2.3 to 3.1).
Induction in pregnancies complicated by SGA at term is associated with a higher risk of instrumental deliveries without improvement of neonatal outcome. Prospective studies are needed to determine the best strategy in suspected IUGR at term.
小于胎龄儿（SGA）与新生儿发病率和死亡率增加相关。目前，缺乏关于这些妊娠应期待管理还是引产的证据。为了解当前政策，我们分析了荷兰国家围产期登记处（PRN）的数据。
我们使用了2000年至2005年间所有头位单胎妊娠、孕周超过36+0周且出生体重低于第10百分位数的初产妇数据。我们分析了两组妊娠：（I）单纯SGA组和（II）SGA合并高血压疾病组。分娩发动与分娩方式和新生儿结局相关。
引产与急诊剖宫产（CS）风险较高相关，且未改善新生儿结局。对于单纯SGA的女性，引产术后急诊CS的相对风险为2.3（95%置信区间[CI]2.1至2.5），对于SGA合并高血压疾病的女性，相对风险为2.7（95%CI 2.3至3.1）。
足月SGA合并妊娠引产与器械助产风险较高相关，且未改善新生儿结局。需要进行前瞻性研究以确定足月疑似胎儿生长受限的最佳策略。
