{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T15:32:47Z","timestamp":1793892767735,"version":"4.8.0"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T00:00:00Z","timestamp":1530662400000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Although no clear evidence exists, many international guidelines advocate early\u2010term delivery of small\u2010for\u2010gestational\u2010age (SGA) fetuses. The aim of this study was to determine whether a risk\u2010stratification protocol in which low\u2010risk SGA fetuses are managed expectantly beyond 37\u2009weeks affects perinatal and maternal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was an impact study examining data collected over a 39\u2010month period (1 January 2013 to 30 April 2016) at a tertiary referral unit. The study included women who were referred to the fetal medicine unit with a singleton non\u2010anomalous fetus diagnosed antenatally as SGA (estimated fetal weight\u2009&lt;\u200910<jats:sup>th<\/jats:sup> centile) from 36\u2009+\u20090\u2009weeks' gestation. In 2014, a protocol for management of SGA was introduced, which included risk stratification with surveillance and expectant management after 37\u2009weeks for lower\u2010risk babies (protocol group). This was compared with the previous strategy, which recommended delivery at around 37\u2009weeks (pre\u2010protocol group). Primary outcome was neonatal composite adverse outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the pre\u2010protocol group, there were 138 SGA babies; in the protocol group there were 143. Mean gestational ages at delivery were 37.4\u2009weeks in the pre\u2010protocol group and 38.2\u2009weeks in the protocol group (<jats:italic>P<\/jats:italic>\u2009=\u20090.04). The incidence of neonatal composite adverse outcome was lower in the protocol group (9% <jats:italic>vs<\/jats:italic> 22%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01), as was neonatal unit admission (13% <jats:italic>vs<\/jats:italic> 39%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Induction of labor and Cesarean section rates were lower, and vaginal delivery rate (83% <jats:italic>vs<\/jats:italic> 60%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) was higher, in the protocol group. Most of the differences were as a result of delayed delivery of SGA babies that were stratified as low risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The findings of this study suggest that protocol\u2010based management of SGA babies may improve outcome, and that identification of moderate SGA should not in isolation  prompt delivery. Larger numbers are required to assess any impact on perinatal mortality. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.17544","type":"journal-article","created":{"date-parts":[[2017,6,10]],"date-time":"2017-06-10T07:42:37Z","timestamp":1497080557000},"page":"66-71","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Small\u2010for\u2010gestational\u2010age babies after 37\u2009weeks: impact study of risk\u2010stratification protocol"],"prefix":"10.1002","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5140-5601","authenticated-orcid":false,"given":"M.","family":"Veglia","sequence":"first","affiliation":[{"name":"Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital University of Oxford  Oxford UK"},{"name":"Department of Obstetrics and Gynaecology, Ospedale Cristo Re  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2539-2648","authenticated-orcid":false,"given":"A.","family":"Cavallaro","sequence":"additional","affiliation":[{"name":"Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital University of Oxford  Oxford UK"},{"name":"Oxford Fetal Medicine Unit, Department of Maternal and Fetal Medicine, The Women's Center Oxford University Hospitals NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Papageorghiou","sequence":"additional","affiliation":[{"name":"Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Black","sequence":"additional","affiliation":[{"name":"Oxford Fetal Medicine Unit, Department of Maternal and Fetal Medicine, The Women's Center Oxford University Hospitals NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4462-112X","authenticated-orcid":false,"given":"L.","family":"Impey","sequence":"additional","affiliation":[{"name":"Oxford Fetal Medicine Unit, Department of Maternal and Fetal Medicine, The Women's Center Oxford University Hospitals NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,4]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10150"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f108"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.82.3.378"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17287"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1806"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2014.06.022"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12020"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.1998.770611.x"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(96)02730-0"},{"key":"e_1_2_5_11_1","first-page":"c7087","article-title":"Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT)","volume":"341","author":"Boers KE","journal-title":"BMJ 2010 21"},{"key":"e_1_2_5_12_1","article-title":"Planned early delivery versus expectant management of the term suspected compromised baby for improving outcomes","volume":"24","author":"Bond D","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_5_13_1","unstructured":"Royal College of Obstetricians and Gynaecologists (RCOG). 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