Does antenatal identification of small‐for‐gestational age fetuses significantly improve their outcome?

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Abstract
Objectives: 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. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.