Comparison study between induced and spontaneous term and preterm births of small-for-gestational-age neonates

Objective: To compare perinatal and maternal outcome between induced and sp ontaneous small-for-gestational-age (SGA) neonates at term and preterm deli veries. Study design: A cross-sectional study was designed and two groups were iden tified at each gestational age: study group-SGA neonates born after inducti on of labor, comparison group-SGA neonates born after spontaneous onset of labor. SGA was decoded as birth weight below 10th percentile. The populatio n consisted of 367 consecutive SGA singleton preterm neonates (24-36 weeks' gestation) and 3921 term SGA neonates (37-42 weeks' gestation) delivered b etween 1990 and 1997. Patients with antepartum death and congenital anomali es were excluded from this study. Results: The prevalence of SGA neonates among preterm deliveries was signif icantly higher than among term deliveries (9.3 versus 6.1%, P < 0.001). The rate of induction of labor among preterm SGA deliveries was significantly higher than term SGA deliveries (17.7 versus 13.4%, P = 0.002). The rates h ypertensive disorders, suspected IUGR, placental abruption, cesarean sectio n, chorioamnionitis and endometritis were significantly higher among preter m SGA than in term SGA. A multiple logistic regression analysis demonstrate d that suspected IUGR, severe PIH (but not mild PIH), chronic hypertension and placental abruption were independent risk factors for induction of labo r among preterm SGA neonates. In addition to these factors, oligohydramnios was considered to be an independent risk factor only among term SGA. No si gnificant differences were found in the mean birthweight and post-partum de ath rates between the induced and spontaneous preterm and term SGA. The inc idence of Apgar score < 7 at 5 min was significantly lower only among induc ed term SGA. Conclusions: Induction of labor in preterm SGA neonates is performed mainly due to maternal severe hypertension disorders. The indications for inducti on of labor among term SGA include maternal hypertensive disorders (mild or severe) as well as neonatal status, represented mainly by oligohydramnios. In addition, induction of labor in preterm or term SGA neonates does not c hange neonatal outcome. Moreover, since no evidence of improved neonatal ou tcome was demonstrated in either indicated group, preterm or term, the ques tion of timing and indications for induction of labor should be discussed. 2001 Elsevier Science Ireland Ltd. All rights reserved.