Induction of labour for intrauterine growth restriction at termBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6768 (Published 21 December 2010) Cite this as: BMJ 2010;341:c6768
- Louise C Kenny, professor1,
- Lesley McCowan, professor2
- 1Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- 2Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
The suspicion of fetal growth restriction at or close to term is a common clinical scenario, but the management of such pregnancies is controversial. Fetuses with growth restriction have a higher risk of perinatal morbidity and mortality. About 40% of stillbirths have been associated with suboptimal fetal growth,1 and the risk of stillbirth increases beyond 37 weeks.2 Consequently, when a suspected growth restricted fetus is detected before birth, obstetricians often induce labour with the aim of reducing the risk of stillbirth. However, induction of labour can be associated with an increase in operative delivery rates, including caesarean section. Thus, other clinicians advocate expectant management, with maternal and fetal monitoring, while awaiting the onset of spontaneous labour⇓.
Little evidence is available to inform best practice about the optimum management of the suspected growth restricted fetus near term. The linked randomised controlled study (DIGITAT) by Boers and colleagues (doi:10.1136/bmj.c7087) compares expectant management with induction of labour.3 Women with pregnancies complicated by suspected fetal growth restriction after 36 weeks’ gestation were randomised to induction of labour or expectant management. The primary …