PHOENIX -- Neonates with intrauterine growth restriction who are delivered by cesarean section for nonreassuring fetal heart rate patterns are at increased risk for adverse perinatal outcomes, Dr. Kara Coassolo reported in a poster session at the annual meeting of the American Institute of Ultrasound in Medicine.
"We may be able to tell moms that babies who are delivered for that reason are at an increased risk for complications later. The need for cesarean delivery [in cases of nonreassuring fetal heart rate patterns] may be a marker for adverse perinatal outcomes," said Dr. Coassolo of the department of obstetrics and gynecology at the University of Pennsylvania, Philadelphia.
Dr. Coassolo and her associates conducted a retrospective cohort study of 865 cases of intrauterine growth restriction (IUGR) in the department over a 5-year period. IUGR was defined as a birth weight below the 10th percentile for gestational age.
Of the 865 infants, 128 (15%) were delivered for nonreassuring fetal heart rate patterns. Investigators compared the clinical outcomes of this group with a control group, which consisted of 737 IUGR fetuses delivered vaginally or by cesarean section for another indication.
Univariate analysis revealed that compared with controls, cesarean section for nonreassuring fetal heart rate patterns was associated with a significantly higher risk for neonatal ICU admission (72% vs. 34%), respiratory distress syndrome (22% vs. 8%), and clinically significant intraventricular hemorrhage (7% vs. 3%).
Neonates delivered by cesarean section were almost two times as likely to have at least one adverse perinatal outcome, compared with controls (29% vs. 15%). Adverse perinatal outcome was defined as having at least one of the following: respiratory distress syndrome, grades 3 and 4 intraventricular hemorrhage, necrotizing enterocolitis, and periventricular leukomalacia, she said at the meeting.
When Dr. Coassolo and her associates adjusted for maternal age, black race, gestational age at delivery, and the incidence of chronic hypertension, those neonates who were delivered by cesarean section for nonreassuring fetal heart rate patterns were 3.41 times more likely than controls to be delivered to the neonatal ICU and 2.21 times more likely to have respiratory distress syndrome.
One study limitation is the fact that the investigators had incomplete information about the mothers' use of prenatal steroids, she said.
BY DOUG BRUNK
San Diego Bureau
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