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The ACOG practice bulletin on intrauterine growth restriction (IUGR), states that these pregnancies are at increased risk of cesarean delivery for non-reassuring fetal status (CD NRFS) but does not specify the rate or the risk factors. The aim of the secondary analysis of our retrospective study was to determine the rate and risk factors for CD NRFS for women in labor, and composite neonatal morbidity (CNM).
All non-anomalous singletons with a sonographic exam before 22 weeks and small-for-gestational age (SGA; birth weight < 10% for GA using Alexander nomogram) that delivered at four centers in 2009 were identified. If IUGR was suspected antenatally, SGA was considered detected and undetected otherwise. CNM included thrombocytopenia, RDS, proven sepsis, grade III/IV IVH, seizure, or death. Mann-Whitney test and multi-variable logistic regression models were used and odds ratio (OR), with 95% confidence intervals (CI) were calculated.
At 4 centers, in 2009, there were 11,487 births and 8% (929) were SGA that met the inclusion criteria. Of the 731 (78%) women who labored, the rate of CD NRFS was 22% (160). Significant risk factors for CD NRFS are listed below. The binomial multi-variable stepwise regression model yielded a Cox and Snell R2 of 0.165 (p<.005). Compared to SGA who delivered vaginally, the CNM was significantly higher among those who had CD NR FHRT (RR 4.65, 95% CI 3.16, 6.85).