Risk factors for Cesarean delivery in pregnancy with small‐for‐gestational‐age fetus undergoing induction of labor

Autor: Leah Bagiardi, Anthony Odibo, Rachel G. Sinkey, Chinedu Nwabuobi, Niraj Gowda, Michelle Kuznicki, Linda Odibo, Jourdan E. Schmitz, Hannah Camisasca-Lopina, Nicole Wood, Anaisy Pargas
Rok vydání: 2020
Předmět:
Adult
medicine.medical_specialty
medicine.medical_treatment
Gestational Age
Risk Assessment
Sensitivity and Specificity
Likelihood ratios in diagnostic testing
03 medical and health sciences
Fetal Heart
0302 clinical medicine
Predictive Value of Tests
Pregnancy
Risk Factors
Clinical Decision Rules
Humans
Medicine
Radiology
Nuclear Medicine and imaging
Labor
Induced
030212 general & internal medicine
reproductive and urinary physiology
Retrospective Studies
Fetus
030219 obstetrics & reproductive medicine
Radiological and Ultrasound Technology
Cesarean Section
business.industry
Obstetrics
Infant
Newborn
Reproducibility of Results
Obstetrics and Gynecology
Gestational age
Retrospective cohort study
General Medicine
medicine.disease
Obstetric Labor Complications
Fetal Diseases
Fetal Weight
Reproductive Medicine
Area Under Curve
Labor induction
Infant
Small for Gestational Age
Gestation
Small for gestational age
Female
business
Maternal Age
Zdroj: Ultrasound in Obstetrics & Gynecology. 55:799-805
ISSN: 1469-0705
0960-7692
DOI: 10.1002/uog.20850
Popis: Objectives To identify risk factors for Cesarean delivery and non-reassuring fetal heart tracing (NRFHT) in pregnancies with a small-for-gestational-age (SGA) fetus undergoing induction of labor and to design and validate a prediction model, combining antenatal and intrapartum variables known at the time of labor induction, to identify pregnancies at increased risk of Cesarean delivery. Methods This was a retrospective cohort study of non-anomalous, singleton gestations with a SGA fetus that underwent induction of labor, delivered in a single tertiary referral center between January 2011 and December 2016. SGA was defined as estimated fetal weight (EFW) Results A total of 594 pregnancies were included. Cesarean delivery was performed in 243 (40.9%) pregnancies. Significant risk factors associated with Cesarean delivery, and included in the final model, were maternal age, gestational age at delivery and initial method of labor induction. The bootstrap estimate of the AUC of the final prediction model for Cesarean delivery was 0.82 (95% CI, 0.78-0.86). The model had sensitivity of 64.2%, specificity of 86.9%, positive likelihood ratio (LR) of 4.9 and negative LR of 0.41. The model had good fit (P = 0.617). NRFHT complicated 117 (19.7%) pregnancies. Significant risk factors for NRFHT included EFW 95th percentile or absent/reversed end-diastolic flow) and gestational age at delivery. The final prediction model for NRFHT had an AUC of 0.69 (95% CI, 0.63-0.75) and specificity of 97.0%. Conclusion We identified several significant risk factors for Cesarean delivery and NRFHT among SGA pregnancies undergoing induction of labor. Clinicians may use these risk factors to guide patient counseling and to help anticipate the potential need for operative delivery. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Databáze: OpenAIRE
Externí odkaz: