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

Sima H. Baalbaki; Spencer G. Kuper; Michelle J. Wang; Robin A. Steele; Joseph R. Biggio; Lorie M. Harper

doi:10.1055/s-0037-1608812

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(07): 605-610
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

Authors

Sima H. Baalbaki

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
Spencer G. Kuper

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
Michelle J. Wang

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
Robin A. Steele

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
Joseph R. Biggio

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
Lorie M. Harper

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

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.

Keywords

intrauterine growth restriction - preterm delivery - mode of delivery - umbilical artery Dopplers

Full Text

References

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