Amer J Perinatol
DOI: 10.1055/s-0037-1608812
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Intended Mode of Delivery on Outcomes in Preterm Growth-Restricted Fetuses

Sima H. Baalbaki1, Spencer G. Kuper1, Michelle J. Wang1, Robin A. Steele1, Joseph R. Biggio1, Lorie M. Harper1
  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, School of Medicine at the University of Alabama at Birmingham, Birmingham, Alabama
Further Information

Publication History

16 March 2017

12 October 2017

Publication Date:
28 November 2017 (eFirst)

Abstract

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.

Condensation

Planned cesarean delivery was not associated with a reduction in neonatal morbidity, even when considering only those with absent or reversed umbilical artery Doppler.