Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome?
OBJECTIVE
Most obstetric clinics have a program for the identification of small-for-gestational age (SGA) fetuses because of the increased risk of fetal complications that they present. We have a structured model for the identification and follow-up of SGA pregnancies. We aimed to determine whether the recognition of SGA antepartum improves fetal outcome.


METHODS
All pregnancies at Malmö University Hospital from 1990 to 1998 (n = 26 968) were reviewed. SGA fetuses identified prior to delivery (n = 681) were compared with those not identified (n = 573). Also, all pregnancies with SGA fetuses were compared with those appropriate-for-gestational age (AGA) (n = 24 585). The risk of serious fetal complications (hypoxic encephalopathy grade 2 or 3, intracranial hemorrhage, Apgar score <4 at 5 min, neonatal convulsions, umbilical pH <7.0, cerebral palsy, mental retardation, stillbirth, intrapartum or infant death) was assessed with cross-tabulation and logistic regression analysis, adjusted for gestational age and degree of SGA.


RESULTS
When compared with SGA fetuses identified before delivery (54%), SGA fetuses not identified before delivery were characterized by a four-fold increased risk of adverse fetal outcome (odds ratio, 4.1; 95% CI, 2.5-6.8). Similarly, compared with AGA fetuses, SGA fetuses were associated with a four-fold increased risk of serious fetal complications.


CONCLUSIONS
A structured antenatal surveillance program for fetuses identified as SGA results in a lower risk of adverse fetal outcome, compared with cases of SGA fetuses not identified antepartum.
Lindqvist
P G
PG
Department of Obstetrics and Gynecology, Malmö University Hospital, Malmö, Sweden. Pelle.Lindqvist@obst.mas.lu.se
Molin
J
J
D001925:Brain Damage, Chronic; D016022:Case-Control Studies; D005260:Female; D005313:Fetal Death; D005316:Fetal Distress; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007743:Labor, Obstetric; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012306:Risk; D016216:Ultrasonography, Prenatal