Research Article| Volume 171, ISSUE 2, P257-261, December 2013

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Induction of labor for term small-for-gestational-age fetuses: what are the consequences?

Published:October 03, 2013DOI:



      To evaluate whether early term labor induction for suspected intrauterine growth restriction (weeks 37–39) improves neonatal outcome for small-for-gestational-age (SGA) neonates.

      Study design

      Delivery room data for 2004–2008 from a single tertiary medical center were linked to neonatal discharge data from the same institution. Data were limited to all singleton, liveborn SGA neonates born at 37–42 weeks of gestation and their mothers. Births with known congenital anomalies were excluded. Women undergoing induction of labor for suspected growth restriction between 37 and 39 weeks’ gestation (early induction SGA) were compared with women who gave birth to term SGA neonates without early induction. SGA (<10th percentile for gestational age and gender) was used as a surrogate for intrauterine growth restriction. Associations between early term labor induction and neonatal morbidities were estimated using logistic regression.


      A total of 2378 SGA neonates meeting study criteria were identified. Of these, 445 underwent early term induction and 1933 were in the non-early induction SGA group. Intrauterine demise among term (37–42 weeks) SGAs occurred in one case at 37 weeks. Early term induction for SGA was associated with an increased risk of cesarean delivery. Several neonatal complications, including hyperbilirubinemia, hypoglycemia and respiratory complications were more prevalent in the early induction SGA group. The increased odds for neonatal complications persisted after controlling for possible confounders.


      Early term induction for SGA fetuses results in an increased risk of cesarean deliveries as well as neonatal metabolic and respiratory complications, with no apparent neonatal benefit.


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        • McIntire D.D.
        • Bloom S.L.
        • Casey B.M.
        • Leveno K.J.
        Birth weight in relation to morbidity and mortality among newborn infants.
        N Engl J Med. 1999; 340: 1234-1238
        • Spinillo A.
        • Capuzzo E.
        • Egbe T.O.
        • Fazzi E.
        • Colonna L.
        • Nicola S.
        Pregnancies complicated by idiopathic intrauterine growth retardation. Severity of growth failure, neonatal morbidity and two-year infant neurodevelopmental outcome.
        J Reprod Med. 1995; 40: 209-215
        • Doctor B.A.
        • O’Riordan M.A.
        • Kirchner H.L.
        • Shad D.
        • Hack M.
        Perinatal correlates and neonatal outcomes of small for gestational age infants born at term gestation.
        Am J Obstet Gynecol. 2001; 185: 652-659
        • Jarvis S.
        • Glinianaia S.V.
        • Torrioli M.G.
        • et al.
        Cerebral palsy and intrauterine growth in single births: European collaborative study.
        Lancet. 2003; 362: 1106-1111
        • Blair E.
        • Stanley F.
        Intrauterine growth and spastic cerebral palsy. I. Association with birth weight for gestational age.
        Am J Obstet Gynecol. 1990; 162: 229-237
        • Ott W.J.
        Small for gestational age fetus and neonatal outcome: reevaluation of the relationship.
        Am J Perinatol. 1995; 12: 396-400
        • Strauss R.S.
        • Dietz W.H.
        Growth and development of term children born with low birth weight: effects of genetic and environmental factors.
        J Pediatr. 1998; 133: 67-72
        • Sommerfelt K.
        • Andersson H.W.
        • Sonnander K.
        • et al.
        Cognitive development of term small for gestational age children at five years of age.
        Arch Dis Child. 2000; 83: 25-30
        • Sommerfelt K.
        • Andersson H.W.
        • Sonnander K.
        • et al.
        Behavior in term, small for gestational age preschoolers.
        Early Hum Dev. 2001; 65: 107-121
        • Sommerfelt K.
        • Sonnander K.
        • Skranes J.
        • et al.
        Neuropsychologic and motor function in small-for-gestation preschoolers.
        Pediatr Neurol. 2002; 26: 186-191
        • Clausson B.
        • Cnattingius S.
        • Axelsson O.
        Preterm and term births of small for gestational age infants: a population-based study of risk factors among nulliparous women.
        Br J Obstet Gynaecol. 1998; 105: 1011-1017
        • Chard T.
        • Yoong A.
        • Macintosh M.
        The myth of fetal growth retardation at term.
        Br J Obstet Gynaecol. 1993; 100: 1076-1081
        • Ohel G.
        • Ruach M.
        Perinatal outcome of idiopathic small for gestational age pregnancies at term: the effect of antenatal diagnosis.
        Int J Gynaecol Obstet. 1996; 55: 29-32
        • Jahn A.
        • Razum O.
        • Berle P.
        Routine screening for intrauterine growth retardation in Germany: low sensitivity and questionable benefit for diagnosed cases.
        Acta Obstet Gynecol Scand. 1998; 77: 643-648
        • Hershkovitz R.
        • Erez O.
        • Sheiner E.
        • et al.
        Comparison study between induced and spontaneous term and preterm births of small-for-gestational-age neonates.
        Eur J Obstet Gynecol Reprod Biol. 2001; 97: 141-146
        • Verlijsdonk J.W.
        • Winkens B.
        • Boers K.
        • Scherjon S.
        • Roumen F.
        Suspected versus non-suspected small-for-gestational age fetuses at term: perinatal outcomes.
        J Matern Fetal Neonatal Med. 2012; 25: 938-943
        • Boers K.E.
        • van der Post J.A.
        • Mol B.W.
        • van Lith J.M.
        • Scherjon S.A.
        Labour and neonatal outcome in small for gestational age babies delivered beyond 36 + 0 weeks: a retrospective cohort study.
        J Pregnancy. 2011; 2011: 293516
        • Lindqvist P.G.
        • Molin J.
        Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome?.
        Ultrasound Obstet Gynecol. 2005; 25: 258-264
        • Shavit T.
        • Ashual E.
        • Regev R.
        • Sadeh D.
        • Fejgin M.D.
        • Biron-Shental T.
        Is it necessary to induce labor in cases of intrauterine growth restriction at term?.
        J Perinat Med. 2012; 40: 539-543
        • Boers K.E.
        • Vijgen S.M.
        • Bijlenga D.
        • et al.
        Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT).
        BMJ. 2010; 341: c7087
        • Dollberg S.
        • Haklai Z.
        • Mimouni F.B.
        • Gorfein I.
        • Gordon E.S.
        Birth weight standards in the live-born population in Israel.
        Isr Med Assoc J. 2005; 7: 311-314
        • Van Wyk L.
        • Boers K.E.
        • van der Post J.A.
        • et al.
        Effects on (neuro)developmental and behavioral outcome at 2 years of age of induced labor compared with expectant management in intrauterine growth-restricted infants: long-term outcomes of the DIGITAT trial.
        Am J Obstet Gynecol. 2012; 206 (406.e1–7)
        • Simchen M.J.
        • Ofir K.
        • Moran O.
        • Kedem A.
        • Sivan E.
        • Schiff E.
        Thrombophilic risk factors for placental stillbirth.
        Eur J Obstet Gynecol Reprod Biol. 2010; 153: 160-164
        • Koopmans C.M.
        • Bijlenga D.
        • Groen H.
        • et al.
        Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial.
        Lancet. 2009; 374: 979-988
        • Maslovitz S.
        • Shenhav M.
        • Levin I.
        • et al.
        Outcome of induced deliveries in growth-restricted fetuses: second thoughts about the vaginal option.
        Arch Gynecol Obstet. 2009; 279: 139-143