Intrauterine growth retardation: induce or wait?

In a study presented at the annual meeting of the Society for Maternal-Fetal Medicine (SMFM-Society for Maternal Fetal Medicine), the Pregnancy Meeting ™ in Chicago, a research group has shown results that indicate that in case of intrauterine growth retardation (IUGR), spontaneous labor can be expected to be equally effective to induce.

Intrauterine growth retardation (IUGR) implies that the unborn child is substantially smaller than usual, and affects approximately 10% of pregnancies.

At birth, IUGR infants are more likely to experience hypoglycemia (low blood sugar), difficulty maintaining body temperature, and an abnormally high number of red blood cells. They are also prone to neonatal jaundice, infections and cerebral palsy. As they grow, babies who had CIR may be more likely to have behavioral disorders, obesity, heart disease, type II diabetes and hypertension.

Due to lack of sufficient studies, obstetricians are two different policies in pregnancies with suspected intrauterine growth retardation. Some doctors prefer to induce labor, while others prefer to wait for spontaneous labor to avoid the high incidence of operative delivery (forceps, vacuum, spatulas) related to the inductions. Researchers at the obstetric research consortium in the Netherlands conducted a randomized controlled clinical trial of 650 women in 52 hospitals, to compare both strategies.

Pregnant women with one baby, with suspicion of IUGR after 36 weeks of gestation were randomly assigned to a group of labor induction or expectant management group. The mean birth weight was significantly lower in the group which underwent labor induction, 2.420 kg, compared to 2.560 kg in the group where they waited for spontaneous labor. Adverse neonatal outcomes (babies with any kind of difficulty at birth) were similar in both groups. The results show that waiting is a strategy at least as effective for inducing labor.

"We now have evidence-based reasons to identify the attention we pay to every delivery, and to invite women to take the decision that they feel most comfortable," said Dr. Kim Boers, of the University of Leiden (Netherlands Netherlands).