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Women with small babies can safely wait for labour

Expectant monitoring is as effective as induction for a growth-restricted baby

OnMedica staff

Thursday, 04 February 2010

Women carrying a single baby that is suspected of being growth restricted at term can be reassured that waiting for birth is as effective as inducing labour, according to new research. The randomised, controlled study is being presented at today’s meeting of the Society for Maternal-Fetal Medicine, in Chicago.

About 10% of pregnant women are told that their baby has intrauterine growth restriction (IUGR), which means that at or after birth he or she is more prone to low blood glucose levels, problems with maintaining body temperature, a higher than usual red blood cell count, jaundice, infections and cerebral palsy.

Conflicting strategies have encouraged either induction of labour to try to reduce the rate of complications, or awaiting spontaneous labour in attempting to avoid operative delivery. However, there has previously been an absence of evidence about the effectiveness of either policy.

The researchers recruited 650 women from 52 hospitals in the Netherlands. They were 36 or more weeks pregnant with a single baby, thought to have growth retardation. The women were randomly allocated to either induction of labour or to expectant monitoring.

Median birth weight was significantly lower in the induction group (2410g) than in the expectant monitoring group (2580g).

Adverse neonatal outcome – defined as a composite of death before hospital discharge, 5-minute Apgar score <7, umbilical artery pH <7.05, or admission to neonatal intensive care – occurred in 6.2% of induced babies and 6.1% of babies of mothers in the spontaneous labour group.

Unsurprisingly, birth occurred earlier in the induction group, with a mean difference of 9.6 days. Delivery was by caesarean section in 13.6% of induced and 13.3% of spontaneous labours.

The authors say that their results show that waiting is an equally effective strategy to inducing labour: “We now have an evidence-based reason to individualise care and to allow women to do what they are most comfortable with when deciding whether to induce labour or wait, although long-term outcomes have to be awaited.”

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