Prognostic Factors of Successful Cervical Ripening and Labor Induction in Late-Onset Fetal Growth Restriction

Abstract

Objective: The aim of this work was to identify independent risk factors influencing the achievement of vaginal delivery among women undergoing labor induction for late-onset fetal growth restriction (FGR). Methods: This was a retrospective cohort study of 201 singleton pregnancies with late-onset FGR (diagnosed > 32 + 0 weeks) that required labor induction with cervical ripening from 37 + 0 weeks, either with dinoprostone (from 2014 to 2015) or Foley balloon (from 2016 to 2018). Independent factors for successful vaginal delivery were identified. A prediction model of vaginal delivery with the identified factors was made using logistic regression and bootstrapping with 1,000 re-samples performed for bias correction. Results: Perinatal results were more favorable in the vaginal delivery group, with significantly lower neonatal admission rates (4.0 vs. 13.7%) and lower composite neonatal morbidity (4.0 vs. 15.7%). The labor induction method (Foley balloon), higher cerebro-pla-cental ratio, lower pre-gestational BMI, and absence of preeclampsia were identified as independent factors associated to vaginal delivery. The area under the curve of the model was of 0.75 (95% CI 0.70-0.79). Conclusions: The use of a Foley balloon is the only modifiable risk factor to improve the chances of vaginal delivery when attempting induction of labor in singleton pregnancies with late-onset FGR.

Severe smallness as predictor of adverse perinatal outcome in suspected late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

“…All HSROC curves are shown in Figure 2. Data for predicting admission to the NICU were available in 11 studies 12,[28][29][30][31][32][33][34][35][36][37] . Detection rates at 25% and 50% false-positive rates (FPRs) were 48% and 76%, respectively.…”

“…Data for predicting neonatal acidosis were available in 12 studies 12,[28][29][30][31][32][33][34][35][36][37][38] . Pooled AUC, Se, Sp, LR+ and LR-values were 53.6%, 45.5% (95% CI, 28.9-63.1%), 61.9% (95% CI, 43.4-77.5%), 1.21 (95% CI, 0.97-1.50) and 0.86 (95% CI, 0.75-1.03), respectively.…”

“…LR+, positive likelihood ratio; LR−, negative likelihood ratio; prob, probability. 2014) 12 Gomez-Roig (2015) 28 Rial-Crestelo (2019) 32 Hendrix (2019) 31 Rizzo (2019) 33 Spinillo (2019) 34 Molina (2020) 35 Rizzo (2020) 36 Villalaín (2020) 37 Morales-Roselló (2021) 38 Savchev (2014) 12 Gomez-Roig (2015) 28 Pérez-Cruz (2015) 29 Rial-Crestelo (2019) 32 Bekkering (2019) 30 Hendrix (2019) 31 Rizzo (2019) 33 Spinillo (2019) 34 Molina (2020) 35 Rizzo (2020) 36 Villalaín (2020) 37 Savchev (2014) 12 Gomez-Roig (2015) 28 Pérez-Cruz (2015) 29 Rial-Crestelo (2019) 32 Bekkering (2019) 30 Hendrix (2019) 31 Rizzo (2019) 33 Spinillo (2019) 34 Molina (2020) 35 Rizzo (2020) 36 Villalaín (2020) 37 Morales-Roselló (2021) 38 Savchev (2014) 12 Gomez-Roig (2015) 28 Rial-Crestelo (2019) 32 Bekkering (2019) 30 Hendrix (2019) 31 Rizzo (2019) 33 Spinillo (2019) 34 Molina (2020) 35 Villalaín (2020) 37 Morales-Roselló (2021) 38 Savchev (2014)…”

“…After review, 12 cohort studies 12,[28][29][30][31][32][33][34][35][36][37][38] were included (Figure 1). The following authors sent additional data to supplement their reported studies: Savchev et al 12 , Gomez-Roig et al 28 , Pérez-Cruz et al 29 , Bekkering et al 30 , Hendrix et al 31 , Rial-Crestelo et al 32 , Rizzo et al 33 , Spinillo et al 34 , Molina et al 35 , Rizzo et al 36 , Villalaín et al 37 , Morales-Rosell ó et al 38 , Demirci et al 39 , Arias-Ortega et al 40 and Mori et al 41 . However, inputs from Demirci et al 39 , Arias-Ortega et al 40 and Mori et al 41 were not included in the final analysis.…”

Prospective comparison of cervical ripening with double balloon Cook catheter, misoprostol or dinoprostone in term singleton pregnancies

“…The use of cervical maturation methods has been shown to reduce the necessity of caesarean section when compared to initiating oxytocin induction in women with unfavorable cervix [15]. Induction of labor in the terrain of unfavorable cervix is associated with prolonged labor when compared to spontaneous onset of labor or induction of labor in a favorable cervix [16,17].…”