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Am J Obstet Gynecol. 2013 May;208(5):376.e1-7. doi: 10.1016/j.ajog.2013.02.030. Epub 2013 Mar 21.

Risk of stillbirth after 37 weeks in pregnancies complicated by small-for-gestational-age fetuses.

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  • 1Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.

Abstract

OBJECTIVE:

The evidence for delivering small-for-gestational-age (SGA) fetuses at 37 weeks remains conflicting. We examined the risk of stillbirth per week of gestation beyond 37 weeks for pregnancies complicated by SGA.

STUDY DESIGN:

Singleton pregnancies undergoing routine second trimester ultrasound from 1990-2009 were examined retrospectively. The risk of stillbirth per 10,000 ongoing SGA pregnancies with 95% confidence intervals (CIs) was calculated for each week of gestation ≥37 weeks. Using a life-table analysis with correction for censoring, conditional risks of stillbirth, cumulative risks of stillbirth per 10,000 ongoing SGA pregnancies and relative risks (RRs) were calculated with 95% CIs for each week of gestation.

RESULTS:

Among 57,195 pregnancies meeting inclusion criteria the background risk of stillbirth was 56/10,000 (95% CI, 42.3-72.7) with stillbirth risk for SGA pregnancies of 251/10,000 (95% CI, 221.2-284.5). The risk of stillbirth after the 37th week was greater compared with pregnancies delivered in the 37th week (47/10,000, 95% CI, 34.6-62.5 vs 21/10,000, 95% CI, 13.0-32.1; RR, 2.2; 95% CI, 1.3-3.7). The cumulative risk of stillbirth rose from 28/10,000 ongoing SGA pregnancies at 37 weeks to 77/10,000 at 39 weeks (RR, 2.75; 95% CI, 1.79-4.2). Among pregnancies complicated by SGA <5% the cumulative risk of stillbirth at 38 weeks was significantly greater than the risk at 37 weeks (RR, 2.3; 95% CI, 1.4-3.8).

CONCLUSION:

There is a significantly increased risk of stillbirth in pregnancies complicated by SGA delivered after the 37th week. Given these findings, we advocate a policy of delivery of SGA pregnancies 37-38 weeks.

Copyright © 2013 Mosby, Inc. All rights reserved.

PMID:
23523099
[PubMed - indexed for MEDLINE]
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