Suspected versus non-suspected small-for-gestational age fetuses at term: perinatal outcomes

Objective: To compare perinatal outcomes of suspected versus non-suspected small-for-gestational age fetuses (SGA) at term. Methods: Retrospective cohort study among all term singleton neonates with a birth weight <10th percentile born in the Parkstad region between 1 January 2006 and 3 March 2008. The subjects were assigned to a prenatally suspected or non-suspected SGA group. Primary outcome was adverse neonatal outcome at birth, defined as a composite of intrauterine fetal death, Apgar <7 at 5 min, or pH umbilical artery <7.05. Secondary outcome included neonatal medium care unit (NMCU) admission >= 7 days. Results: 430 subjects were included in the study; 36.7% was suspected of SGA. In the suspected SGA group mean gestational age at birth and birth weight were significantly lower, whereas maternal morbidity was significantly higher. The incidence of labor induction and elective cesarean section were also significantly higher in the suspected SGA group. Total perinatal mortality was 2.1%. Identification of SGA and subsequent management led to a significant decrease of adverse neonatal outcome at birth, but did not lead to a significant decrease in NMCU admission >= 7 days. Conclusions: Suspicion of SGA was associated with a more active management of labor and delivery, resulting in a better neonatal outcome at birth.