title: Induction of labor for term small-for-gestational-age fetuses: what are the consequences?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Keren
authors.initials: K
authors.lastname: Ofir
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.forename: Eran
authors.initials: E
authors.lastname: Zilberberg
authors.forename: Eyal
authors.initials: E
authors.lastname: Schiff
authors.forename: Michal J
authors.initials: MJ
authors.lastname: Simchen
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007751:Labor, Induced; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
keywords: Induction of labor; SGA; Small for gestational age; Term SGA