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Most FGR patients deliver vaginally after induction of labor

Key clinical point: Consider a trial of labor after labor induction in pregnant women with fetal growth restriction.

Major finding: A total of 81% of patients delivered vaginally after labor induction; 88% of C-sections were for nonreassuring fetal heart rate tracing.

Data source: A retrospective cohort study of 134 patients.

Disclosures: Dr. Horowitz reported having no disclosures.


 

AT THE ACOG ANNUAL CLINICAL MEETING

CHICAGO – Induction of labor is reasonable in cases involving fetal growth restriction, as most patients who are induced deliver vaginally rather than by cesarean section, according to findings from a retrospective cohort study.

Of 134 patients who underwent induction of labor for fetal growth restriction (FGR), 81% delivered vaginally, Dr. Kari Horowitz reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In those who delivered by C-section, the indication was nonreassuring fetal heart rate in 88% of cases, according to Dr. Horowitz, of the University of Connecticut, Farmington.

The cesarean delivery rates were highest in cases involving nulliparity, prematurity, hypertension, oligohydramnios, and use of prostaglandins. Logistic regression analysis showed that only prematurity was significantly associated with cesarean delivery (odds ratio, 3.81).

The findings are based on a chart review of all patients with singleton pregnancy, a non-anomalous fetus, and suspected FGR (estimated fetal weight and/or fetal abdominal circumference less than the 10th percentile, or no interval growth) who delivered between January 2008 and December 2012. Patients were excluded from the study if there was multiple gestation; fetal anomalies or aneuploidy; malpresentation; a history of prior cesarean delivery; or other contraindications to vaginal delivery.

Although FGR is associated with neonatal risks, including intrauterine demise, neonatal morbidity and mortality, and postnatal morbidity, it is not considered an indication for cesarean delivery. Affected fetuses, however, may be at risk for nonreassuring fetal heart rate tracing and fetal distress due to uteroplacental insufficiency. Delivery at 38 to 39 6/7 weeks is recommended in cases of isolated FGR, and delivery before 38 weeks is recommended in cases with additional risk factors for adverse outcomes.

"Prior studies have found increased risk of cesarean delivery in FGR neonates undergoing induction of labor as compared to spontaneous labor, and no difference in rates of cesarean delivery or adverse outcomes in patients undergoing induction of labor versus expectant management. Term FGR fetuses have been found to have significantly higher rates of cesarean delivery for nonreassuring fetal heart rate tracing," Dr. Horowitz noted.

"It is recommended that these patients undergo a trial of labor," Dr. Horowitz concluded, noting that preterm patients should be counseled about the increased risk of cesarean delivery for nonreassuring fetal heart tracing.

Dr. Horowitz reported having no disclosures.

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