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Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000447353.92329.19
Monday, April 28, 2014: PDF Only

Induction of Labor for Fetal Growth Restriction: Risk Factors for Primary Cesarean Delivery.

Horowitz, Kari M. MD; Feldman, Deborah MD

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Abstract

INTRODUCTION: Fetal growth restriction is associated with intrauterine fetal demise, neonatal morbidity, and death. Late-term delivery is optimal for isolated fetal growth restriction without other risk factors. Fetal growth restriction alone is not an indication for cesarean delivery unless there is a nonreassuring fetal heart rate tracing. These patients may undergo induction of labor. We sought to identify risk factors that may predict primary cesarean delivery for nonreassuring fetal heart rate tracing in cases of induction of labor for fetal growth restriction.

METHODS: We reviewed charts of all patients found to have fetal growth restriction and delivered from January 2008 to December 2012. Excluded were multiple-fetal gestations, known aneuploidy, fetal structural anomalies, and contraindication to vaginal delivery. Patient characteristics evaluated included gestational age, parity, hypertension, diabetes, tobacco use, estimated fetal weight, amniotic fluid index, umbilical artery Dopplers, and prostaglandin use. Characteristics of patients who underwent induction of labor but delivered by cesarean delivery were compared with those who delivered vaginally. Data were analyzed using [chi]2 and multivariate logistic regression. A P value of <.05 was considered significant.

RESULTS: One hundred thirty-four patients underwent induction of labor underwent induction of labor for fetal growth restriction. Of these, 81% delivered vaginally. Indication for cesarean delivery was nonreassuring fetal heart rate tracing in 88% of cases. Cesarean delivery rates were higher for nulliparity, prematurity, hypertension, oligohydramnios, and prostaglandin use. Logistic regression showed only prematurity (odds ratio 3.81, 95% confidence interval 1.07-13.53) was significantly associated with cesarean delivery.

CONCLUSION: The rate of vaginal delivery is high in cases of induction of labor for fetal growth restriction. It is reasonable for these patients to undergo an induction of labor. Preterm patients should be counseled regarding a higher risk for cesarean delivery.

(C) 2014 by The American College of Obstetricians and Gynecologists.

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