TY - JOUR
T1 - Impact of Intended Mode of Delivery on Outcomes in Preterm Growth-Restricted Fetuses
AU - Baalbaki, Sima H.
AU - Kuper, Spencer G.
AU - Wang, Michelle J.
AU - Steele, Robin A.
AU - Biggio, Joseph R.
AU - Harper, Lorie M.
N1 - Publisher Copyright:
© 2018 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - 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.
AB - 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.
KW - intrauterine growth restriction
KW - mode of delivery
KW - preterm delivery
KW - umbilical artery Dopplers
UR - http://www.scopus.com/inward/record.url?scp=85035766469&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85035766469&partnerID=8YFLogxK
U2 - 10.1055/s-0037-1608812
DO - 10.1055/s-0037-1608812
M3 - Article
C2 - 29183094
AN - SCOPUS:85035766469
SN - 0735-1631
VL - 35
SP - 605
EP - 610
JO - American Journal of Perinatology
JF - American Journal of Perinatology
IS - 7
ER -