(377) Cesarean delivery rate among pregnancies with fetal growth restriction

To determine the incidence of cesarean section (CS) in patients diagnosed with fetal growth restriction (FGR)

Study Design:

This is a retrospective cohort study conducted at a single, urban institution of all singleton, nonanomalous pregnancies with no known genetic disorder that had a diagnosis of FGR (defined as estimated fetal weight (EFW) < 10th% or abdominal circumference (AC) < 10th%). All included patients were candidates for vaginal delivery. The severity of FGR was classified into 2 groups: < 3rd% and/or abnormal umbilical artery (UA) Doppler and EFW 4-9th% or AC < 10th% and normal UA Doppler. Maternal demographics, gestational age at delivery, and indication for delivery were collected. Outcomes were analyzed using t-test and Chi-square.

Results:

Of the 179 patients meeting inclusion criteria, a total of 24 patients (13.4%) underwent CS. Overall, 36/179 (20.1%) patients had EFW < 3rd% and/or abnormal UA Doppler and 143/179 (79.9%) had EFW 4-9th% and normal UA Doppler, with no significant difference between delivery modes (Table 1). Non reassuring fetal status was the indication for cesarean in 14/24 (58%) of patients. Successful vaginal delivery after CS was noted in 8/13 (61.5%). Compared to patients who delivered vaginally, patients who delivered via CS were more likely to have pre-eclampsia (25% vs. 5.2%, p=0.001), a prior CS (20.8% vs. 5.2%, p=0.006) or be induced before 37 weeks (20.8% vs.7.8%, p=0.042) (Table 1). The nulliparous, term, singleton, vertex CS rate was 11/56 (19.6%) and the preterm rate was 22/179 (12.3%), which are comparable to the national general population rate of 25%.

Conclusion:

Patients with an antenatal diagnosis of FGR have similar CS rates when compared to the general population. This information will assist in counseling patients with FGR when discussing mode of delivery.