Question: 31 weeks, para 3 with previous normal vaginal deliveries with previous IUGR, current pregnancy IUGR (below 3rd centile), normal AFI and normal dopplers, abnormal biophysical profile, reassuring CTG and absent fetal movements, cephalic presentation Should we
- deliver this baby
- if yes, within what time frame
- If no, how to monitor
- if yes, what mode - induction or elective caesarean section?
Answer: The NICE 2008 guideline on induction of labour(1) notes that “For fetal growth restriction identified between 24 and 36 weeks of gestation, there is insufficient evidence to determine whether immediate or delayed birth is beneficial” and makes the recommendation that “If there is severe fetal growth restriction with confirmed fetal compromise, induction of labour is not recommended.”
A Cochrane review of regimens of fetal surveillance for impaired fetal growth (2) concludes: “There is limited evidence from randomised controlled trials to inform best practice for fetal surveillance regimens when caring for women with pregnancies affected by impaired fetal growth. More studies are needed to evaluate the effects of currently used fetal surveillance regimens in impaired fetal growth.”
References:
- National Institute for Health and Clinical Excellence. Induction of labour. London: RCOG Press, 2008
- Grivell RM, Wong L, Bhatia V. Regimens of fetal surveillance for impaired fetal growth. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007113. DOI: 10.1002/14651858.CD007113.pub2. Abstract and full text in selected countries. Full text available for Fellows, Members and Trainees through OVID
Search date: June 2009
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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