Impact of Intended Mode of Delivery on Outcomes in Preterm Growth-Restricted Fetuses
16 March 2017
12 October 2017
28 November 2017 (eFirst)
Background Scheduled cesarean is frequently performed for fetal growth restriction due to concerns for fetal intolerance of labor.
Objective We compared neonatal outcomes in preterm growth-restricted fetuses by intended mode of delivery.
Study Design We performed a retrospective cohort study of indicated preterm births with prenatally diagnosed growth restriction from 2011 to 2014 at a single institution. Patients were classified by intended mode of delivery. The primary outcome was a composite of adverse neonatal outcomes, including perinatal death, cord blood acidemia, chest compressions during neonatal resuscitation, seizures, culture-proven sepsis, necrotizing enterocolitis, and grade III–IV intraventricular hemorrhage. Secondary analysis was performed examining the impact of umbilical artery Dopplers.
Results Of 101 fetuses with growth restriction, 75 underwent planned cesarean deliveries. Of those induced, 46.2% delivered vaginally. Delivery by scheduled cesarean was not associated with a decreased risk of the composite outcome (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 0.45–5.78), even when only those with abnormal umbilical artery Dopplers were considered (aOR, 2.8; 95% CI, 0.40–20.2).
Conclusion In this cohort, planned cesarean was not associated with a reduction in neonatal morbidity, even when considering only those with abnormal umbilical artery Dopplers. In otherwise appropriate candidates for vaginal delivery, fetal growth restriction should not be considered a contraindication to trial of labor.
KeywordsIntrauterine growth restriction - preterm delivery - mode of delivery - umbilical artery Dopplers
Planned cesarean delivery was not associated with a reduction in neonatal morbidity, even when considering only those with absent or reversed umbilical artery Doppler.
- 1 Racusin DA, Antony KM, Haase J, Bondy M, Aagaard KM. Mode of delivery in premature neonates: does it matter?. AJP Rep 2016; 6 (03) e251-e259
- 2 Feige A, Douros A. Mortality and morbidity of small premature infants (<1,500 g) in relation to presentation and delivery mode [in German]. Z Geburtshilfe Neonatol 1996; 200 (02) 50-55
- 3 Mattern D, Straube B, Hagen H. Effect of mode of delivery on early morbidity and mortality of premature infants (< or = 34th week of pregnancy) [in German]. Z Geburtshilfe Neonatol 1998; 202 (01) 19-24
- 4 Haque KN, Hayes AM, Ahmed Z, Wilde R, Fong CY. Caesarean or vaginal delivery for preterm very-low-birth weight (< or =1,250 g) infant: experience from a district general hospital in UK. Arch Gynecol Obstet 2008; 277 (03) 207-212
- 5 American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol 2013; 121 (05) 1122-1133
- 6 Aucott SW, Donohue PK, Northington FJ. Increased morbidity in severe early intrauterine growth restriction. J Perinatol 2004; 24 (07) 435-440
- 7 Garite TJ, Clark R, Thorp JA. Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol 2004; 191 (02) 481-487
- 8 Perrotin F, Simon EG, Potin J, Laffon M. Delivery of the IUGR fetus [in French]. J Gynecol Obstet Biol Reprod (Paris) 2013; 42 (08) 975-984
- 9 Deter RL, Rossavik IK, Harrist RB, Hadlock FP. Mathematic modeling of fetal growth: development of individual growth curve standards. Obstet Gynecol 1986; 68 (02) 156-161
- 10 Kecskes Z, Berrington J, Davies MW. Short-term neonatal outcomes of growth restricted infants by their mode of delivery. Aust N Z J Obstet Gynaecol 2002; 42 (01) 100-101