Maternal-Fetal Medicine Division, Instituto Nacional de Perinatologia, Mexico City, Mexico.
Department of Epidemiology and Public Health, Universidad Panamericana School of Medicine, Mexico City, Mexico.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2286433. doi: 10.1080/14767058.2023.2286433. Epub 2023 Nov 27.
To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode. This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios. Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively ( < 0.001). Among patients with spontaneous labor and those scheduled for labor induction, 63% and 47.8% required an emergency cesarean delivery for intrapartum fetal distress. Compared to elective cesarean delivery, spontaneous labor (OR 4.32 [95% CI 1.79, 10.42], = 0.001; aOR 4.85 [95% CI 1.85, 12.66], = 0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] = 0.002; aOR 5.29 [95% CI 2.01, 13.87], = 0.001) had higher odds of adverse neonatal outcomes. In this cohort of FGR, delivering at ≥34 weeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.
比较胎儿生长受限（FGR）孕妇不同分娩方式的新生儿结局。这是一项回顾性队列研究，纳入了孕龄≥34.0 周的单胎 FGR 孕妇。根据产科医生决定的分娩方式比较新生儿结局。需要注意的是，本研究中所有孕妇均无分娩禁忌证。采用 logistic 回归模型计算粗比数比（OR）及其对应的 95%置信区间（CI），以评估不同分娩方式与新生儿发病率（复合结局，即脐动脉 pH 值≤7.1、5 分钟 Apgar 评分≤7、新生儿重症监护病房收治、低血糖、产时胎儿窘迫需急诊剖宫产和围产儿死亡）之间的潜在关联。敏感性分析排除了复合结局中因产时胎儿窘迫而需行紧急剖宫产分娩的病例，因为仅自发临产或引产的患者才能满足这一标准。调整后的效应模型中的潜在混杂因素包括母亲年龄、体重指数、高血压疾病、糖尿病、FGR 类型（早发性或晚发性）和羊水过少。72 例（34%）孕妇行择期剖宫产，73 例（34%）孕妇自发临产且预计阴道分娩，67 例（32%）孕妇行引产。上述各组的复合结局发生率分别为 65.3%、89%和 88.1%（ < 0.001）。在自发临产和计划引产的孕妇中，63%和 47.8%因产时胎儿窘迫需行紧急剖宫产。与择期剖宫产相比，自发临产（OR 4.32[95%CI 1.79, 10.42]， = 0.001；aOR 4.85[95%CI 1.85, 12.66]， = 0.001）和引产（OR 3.92[95%CI 1.62, 9.49]， = 0.002；aOR 5.29[95%CI 2.01, 13.87]， = 0.001）发生不良新生儿结局的风险更高。在本研究中，对于孕龄≥34 周、自发临产和引产的 FGR 孕妇，其新生儿发病率高于择期剖宫产分娩。
