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Background <p>Fetal growth restriction (FGR) is a major contributor to perinatal morbidity and mortality. While guidelines address timing of delivery, the optimal mode—induction of labor (IOL) versus planned cesarean delivery (CD)—remains uncertain.</p> Objective <p>To evaluate the association between planned mode of delivery and neonatal outcomes in pregnancies complicated by late onset FGR (LOFGR).</p> Study Design <p>We conducted a retrospective cohort study at a tertiary Canadian center (2017–2022). Singleton pregnancies with LOFGR (&gt; 34 weeks’ gestation), defined by Society for Maternal–Fetal Medicine (SMFM) criteria, were eligible if the last ultrasound was within 14 days of delivery. Exclusions included spontaneous labor, delivery &lt; 34 weeks, and contraindications to labor. Planned mode of delivery (IOL vs CD) was the exposure. Outcomes were classified as severe (perinatal death, 5-min Apgar &lt; 4, umbilical arterial pH &lt; 7.05, base deficit ≥ 12 mmol/L, hypoxic-ischemic encephalopathy/therapeutic hypothermia, grade III–IV intraventricular hemorrhage, necrotizing enterocolitis, sepsis, or invasive ventilation &gt; 24 h) or moderate (NICU stay &gt; 72 h, Apgar 4–6, pH 7.05–7.10, non-invasive respiratory support &gt; 6–12 h, transient tachypnea, or brief resuscitation). Multivariable logistic regression adjusted for confounders. A prespecified subgroup applied the ISUOG criteria.</p> Results <p>Of 12,270 deliveries, 1,143 (9.3%) met SMFM criteria for LOFGR; 869 were eligible (192 planned CD, 677 IOL). Severe outcomes and moderate outcomes were more frequent after CD (23.4% vs 16.7%; <i>p</i> = 0.03 and 42.2% vs 31.2%; <i>p</i> &lt; 0.01, respectively). IOL was associated with lower adjusted risk of severe outcomes (aOR 0.35; 95% CI 0.19–0.67) and moderate outcomes (aOR 0.43; 95% CI 0.24–0.76). Results were consistent using ISUOG criteria (aOR 0.33; 95% CI 0.17–0.62 and aOR 0.44; 95% CI 0.25–0.79, respectively) About 20% of induced patients required intrapartum CD.</p> Conclusions <p>IOL was associated with reduced severe and moderate neonatal morbidity compared with planned CD. IOL represents a safe alternative when intrapartum surveillance and timely operative delivery are available.</p>

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Planned mode of delivery and neonatal outcomes in pregnancies complicated by late-onset fetal growth restriction: a retrospective cohort study

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  • 发表日期：

    2026年3月2日

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  • Misgav Rottenstreich,
  • Eran Ashwal,
  • Amal Yousef,
  • Bryon DeFrance,
  • Jon F. R. Barrett,
  • Hen Y. Sela

摘要

Background

Fetal growth restriction (FGR) is a major contributor to perinatal morbidity and mortality. While guidelines address timing of delivery, the optimal mode—induction of labor (IOL) versus planned cesarean delivery (CD)—remains uncertain.

Objective

To evaluate the association between planned mode of delivery and neonatal outcomes in pregnancies complicated by late onset FGR (LOFGR).

Study Design

We conducted a retrospective cohort study at a tertiary Canadian center (2017–2022). Singleton pregnancies with LOFGR (> 34 weeks’ gestation), defined by Society for Maternal–Fetal Medicine (SMFM) criteria, were eligible if the last ultrasound was within 14 days of delivery. Exclusions included spontaneous labor, delivery < 34 weeks, and contraindications to labor. Planned mode of delivery (IOL vs CD) was the exposure. Outcomes were classified as severe (perinatal death, 5-min Apgar < 4, umbilical arterial pH < 7.05, base deficit ≥ 12 mmol/L, hypoxic-ischemic encephalopathy/therapeutic hypothermia, grade III–IV intraventricular hemorrhage, necrotizing enterocolitis, sepsis, or invasive ventilation > 24 h) or moderate (NICU stay > 72 h, Apgar 4–6, pH 7.05–7.10, non-invasive respiratory support > 6–12 h, transient tachypnea, or brief resuscitation). Multivariable logistic regression adjusted for confounders. A prespecified subgroup applied the ISUOG criteria.

Results

Of 12,270 deliveries, 1,143 (9.3%) met SMFM criteria for LOFGR; 869 were eligible (192 planned CD, 677 IOL). Severe outcomes and moderate outcomes were more frequent after CD (23.4% vs 16.7%; p = 0.03 and 42.2% vs 31.2%; p < 0.01, respectively). IOL was associated with lower adjusted risk of severe outcomes (aOR 0.35; 95% CI 0.19–0.67) and moderate outcomes (aOR 0.43; 95% CI 0.24–0.76). Results were consistent using ISUOG criteria (aOR 0.33; 95% CI 0.17–0.62 and aOR 0.44; 95% CI 0.25–0.79, respectively) About 20% of induced patients required intrapartum CD.

Conclusions

IOL was associated with reduced severe and moderate neonatal morbidity compared with planned CD. IOL represents a safe alternative when intrapartum surveillance and timely operative delivery are available.