Fetal growth restriction: risk factors for unplanned primary cesarean delivery

Horowitz, Kari; Feldman, Deborah

doi:10.3109/14767058.2014.980807

Cited by 15 publications

(13 citation statements)

References 3 publications

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“…Induction of labor has been shown to be associated with an increased risk of Cesarean delivery; however, both mathematical modeling and a multicenter randomized trial demonstrated that this is not the case in low‐risk term pregnancies. Nevertheless, among SGA fetuses, there remains a concern for the safety of prostaglandin use for labor induction in pregnancies with fetal growth restriction (FGR).…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for Cesarean delivery in pregnancy with small‐for‐gestational‐age fetus undergoing induction of labor

Nwabuobi

Gowda

Schmitz

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? In this study, we developed an integrated and comprehensive prediction model for assessing the risk of Cesarean delivery in pregnancies with a small-for-gestational-age (SGA) fetus undergoing induction of labor, based on variables known at the time of admission. What are the clinical implications of this work?Clinicians may use these risk factors to guide patient counseling and to help anticipate the potential need for Cesarean delivery, or additional neonatal support at the time of birth, in pregnancies with a SGA fetus undergoing induction of labor. ABSTRACTObjectives To identify risk factors for Cesarean delivery and non-reassuring fetal heart tracing (NRFHT) in pregnancies with a small-for-gestational-age (SGA) fetus undergoing induction of labor and to design and validate a prediction model, combining antenatal and intrapartum variables known at the time of labor induction, to identify pregnancies at increased risk of Cesarean delivery.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have identified certain antenatal and intrapartum risk factors that increase the risk of operative delivery [5][6][7][8][9][10][11][12] . These include abnormal umbilical artery (UA) Doppler studies, low cerebroplacental ratio, oligohydramnios, prostaglandin use and non-reassuring fetal heart tracing (NRFHT).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for Cesarean delivery in pregnancy with small‐for‐gestational‐age fetus undergoing induction of labor

Nwabuobi

Gowda

Schmitz

et al. 2020

Ultrasound in Obstet & Gyne

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“…Other studies identified the main obstetric pathologies (e.g. fetal growth restriction, preeclampsia) as risk factor for primary non-elective CS and invited to consider the maternal characteristics and different assistential levels as potential bias [20,21]. Moreover, the analysis of the indicators in the first two classes of Robson, known to include the women with the lowest risk of CS, showed that fetal distress, malpresentation, and failed induction were the most frequent one.…”

Section: Discussionmentioning

confidence: 99%

Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification

et al. 2020

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Background and Objectives: The incidence of cesarean section (CS) has progressively increased worldwide, without any proven benefit to either the mother or the newborn. The aim of this study was to evaluate the association between CS rates and both clinical and non-clinical variables, while applying the Robson classification system. Materials and Methods: This is a retrospective observational study of pregnant women delivering at a tertiary care hospital between 2012 and 2017, either under public or private healthcare. The overall CS rate, and the elective and non-elective CS rate, divided by classes of Robson, were determined. The rate of vaginal deliveries and CSs was compared between the public and private setting. The distribution of incidence of non-elective CSs and their main indications were analyzed between daytime and nighttime. Results: 18,079 patients delivered during the study period: 69.2% delivered vaginally and 30.8% by CS. Robson class 5 was the most frequent (23.4%), followed by class 2B (16.8%). Of the 289 private practice deliveries, 59.2% were CSs. The CS rate was significantly higher in private compared to public practice: 59.2% and 30.4%, respectively (OR 3.32, 95% CI 2.62 ± 4.21). When only considering elective CSs, a statistically significant difference was found in Robson class 5 between private and public practice, with the latter having more CSs (94.2% and 83.8%, respectively (p = 0.046)). The rate of non-elective CS was significantly lower during nighttime than during daytime (17.2% vs. 21.5%, p < 0.01). During daytime, the higher incidence of CS occurred between 4:00 and 4:59 pm, and during nighttime between 9:00 and 9:59 pm. Failed induction was significantly more common as an indication to CS during daytime when compared to nighttime (p = 0.01). Conclusions: This study identified two non-clinical variables that influenced the CS rate: the type of healthcare setting (private vs. public) and the time of the day. We believe that these indications might be related more to the practitioner attitude, rather than objective delivery complications.

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“…Previous studies have reported that because the delivery of newborns with FGR is associated with NRFS, the rate of cesarean delivery is high (14-40.9%) [18][19][20][21][22][23], particularly in cases with low CPR [23]. The indication for cesarean delivery was fetal distress in 9.5-29% of these cases [18][19][20]. In our study, because women who experienced cesarean delivery before the active phase of labor were excluded, the cesarean delivery rate was only 4% (5/127).…”

Section: Discussionmentioning

confidence: 99%

“…We performed a power analysis, which estimated that 152 women were needed to detect a difference in the cesarean delivery rate of 15% between groups to achieve 80% power and an α-value of 0.05. Based on previous studies, a 15% difference between groups was selected [11,18]. A statistical analysis was performed using JMP® 13 (SAS Institute Inc., Cary, NC, USA).…”

Section: Methodsmentioning

confidence: 99%

Oxytocin Discontinuation During Induced Labor in Pregnancies With Suspected Fetal Growth Restriction

Iwai¹,

Mimura²,

Endo³

et al. 2020

Preprint

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Objective: Although fetal growth restriction (FGR) is associated with an increased risk of cesarean delivery during induced labor, there is little evidence to guide labor management in such cases. This study aimed to investigate whether discontinuation of oxytocin infusion affects the cesarean delivery rate and the risk of maternal and neonatal complications associated with induced labor in pregnancies with suspected FGR.Methods: This was a retrospective cohort study of singleton pregnancies with vertex presentation and indications for labor induction due to FGR after 34.0 weeks of gestation at our institution from January 2010 to December 2017. Two parallel groups were compared: women who received oxytocin continuously until delivery (continuation group) and women whose oxytocin was discontinued at the beginning of the active phase of labor (discontinuation group).Results: There were 74 women in the continuation group and 51 women in the discontinuation group. The incidence of cesarean deliveries was higher (5.4% vs 2.0%) in the continuation group, but this difference was not statistically significant. However, the incidence of uterine tachysystole (23.0% vs 9.8%) was significantly higher in the continuation group than in the discontinuation group. Differences in labor management did not affect the lengths of the active phase and second stage of labor (mean, 136 ± 122 minutes and 34.2 ± 45 minutes, respectively; 122 ± 104 minutes and 48.8±67 minutes in the continuation group and discontinuation group, respectively). The incidence of postpartum hemorrhage and adverse neonatal outcomes were not significantly different between groups.Conclusions: Oxytocin can be safely discontinued after the active phase of labor in women undergoing labor induction for FGR without an increased risk of cesarean delivery or other unfavorable outcomes. Therefore, this strategy may be considered an alternative to continued oxytocin infusion.

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Fetal growth restriction: risk factors for unplanned primary cesarean delivery

Cited by 15 publications

References 3 publications

Risk factors for Cesarean delivery in pregnancy with small‐for‐gestational‐age fetus undergoing induction of labor

Risk factors for Cesarean delivery in pregnancy with small‐for‐gestational‐age fetus undergoing induction of labor

Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification

Oxytocin Discontinuation During Induced Labor in Pregnancies With Suspected Fetal Growth Restriction

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