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Fetal growth restriction (FGR) is associated with increased morbidity and mortality especially in preterm neonates. Cesarean rates among growth-restricted, premature fetuses are reported as high as 50%. The objective of our study was to examine neonatal outcomes in premature growth-restricted fetuses based on mode of delivery.
We performed a retrospective cohort study of patients with antenatally diagnosed FGR (estimated fetal weight less than 10th percentile) from 2006-2016. We included singleton, live born pregnancies delivering between 30-36 weeks’ gestation. Neonates with suspected chromosomal abnormalities or anomalies were excluded. Maternal factors such as smoking, hypertension, parity, and abnormal Dopplers were examined. Neonatal outcomes included respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), 5-minute Apgar <7, neonatal death, and length of NICU stay. Mode of delivery and neonatal outcome were analyzed using Chi square. Logistic regression was used for composite neonatal morbidity. Length of NICU stay was tested using Kruskal-Wallis H test.
Complete data for 200 patients were available for our study. Of these, 50.3% underwent induction of labor and 49.5% underwent planned Cesarean. Ultimately 70.3% of the study population delivered by Cesarean. Composite morbidity was significantly higher in patients undergoing planned Cesarean delivery when compared to those who were induced and delivered vaginally (OR 2.73 [95% CI 1.10-6.75]). This finding remained significant after controlling for hypertension, smoking, parity, and abnormal Doppler studies. There was not an increase in composite morbidity in those patients who underwent induction but ultimately delivered by Cesarean compared with those delivering vaginally. No neonatal deaths occurred in our study population. Neonates delivered by planned Cesarean and Cesarean after induction were found to have a longer stay in the NICU (p <0.001).
Cesarean delivery is common among pregnancies complicated by FGR. Our data demonstrated a lower risk for neonatal morbidity in vaginal deliveries compared with planned Cesareans. These results are helpful for counseling patients regarding mode of delivery in growth restricted fetuses requiring preterm delivery.