Outcome of expectantly managed small-for-gestational-age pregnancies with normal Doppler parameters- a prospective cohort study

Sneha Mishra, Krishna Agarwal


Background: SGA foetuses with normal Dopplers are not at risk of IUD. However, there is lack of consensus about timing of delivery of SGA foetuses. Clinicians commonly induce all SGA pregnancies at 37 weeks. Expectant management of SGA foetuses beyond 37 weeks is not well studied.

Methods: We followed up women with clinically suspected growth restriction with foetal biometry, Doppler and biophysical profile. Pregnancies with foetal AC between 10th to 3rd centile with normal Dopplers were recruited in the study group. The women were allowed to go in spontaneous labor till 39+6/7 weeks or were induced at 39+6/7 weeks. The outcome of such cases was compared with controls who were induced at 37+0/7 weeks.

Results: Spontaneous labor occurred in 42% subjects in study group whereas in control group all were induced. Mean gestation at delivery in the study group was increased (39.57±0.71 versus 37.0±0.0, p value <0.001). Almost 81% of the subjects in study group delivered after 39 weeks. The rate of caesarean section was significantly lower in study group (3% versus 22%, p value-0.024). Also, the risk of intrapartum foetal distress was lower in study group (3/36 versus 1/36).The mean birth weight in the study group was higher (2426.5±154.1 gm versus 2297.9±101.4 gm, p value <0.001.

Conclusions: Expectant management of SGA pregnancies with normal Doppler parameters leads to a significant increase in gestational age at birth and the mean birth weight and a significant reduction in caesarean section rate.



Expectant management, Induction of labor, Mean gestation, SGA, Spontaneous labor

Full Text:



Figueras F, Gratacos E. An integrated approach to fetal growth restriction. Best Pract Res Clin Obstet Gynaecol. 2017;38:48-58.

Lausman A, Kingdom J, Gagnon R, Basso M, Bos H, Crane J, et al. Intrauterine growth restriction: screening, diagnosis and management. J Obstet Gynaecol Can. 2013;35:741-57.

Veglia M, Cavallaro A, Papageorghiou A, Black R, Impey L. Small-for-gestational-age babies after 37 weeks: impact study of risk-stratification protocol. Ultrasound Obstet Gynecol. 2018;52:66-71.

Hidaka N, Sato Y, Kido S, Fujita Y, Kato K. Expectant management of pregnancies complicated by fetal growth restriction without any evidence of placental dysfunction at term: Comparison with routine labor induction. J Obstet Gynaecol Res. 2018;44:93-101.

Boers KE, van der Post JA, Mol BW, van Lith JM, Scherjon SA. Labour and neonatal outcome in small for gestational age babies delivered beyond 36+0 weeks: a retrospective cohort study. J Pregnanc. 2011;2011:293516.

Boers KE, Vijgen SM, Bijlenga D, van der Post JA, Bekedam DJ, Kwee A, et al. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ. 2010;341:c7087.

American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal