Ultrasound/Imaging
Poster Session 4
Misgav Rottenstreich, MBA, MD (he/him/his)
Clinical Fellow
McMaster University
Hamilton, ON, Canada
Swati Agrawal, MD, MSCR
Hamilton Health Sciences
Toronto, ON, Canada
Homero Flores Mendoza, MD
McMaster University
Hamilton, ON, Canada
Bryon DeFrance, MD
McMaster University
Hamilton, ON, Canada
Jon F. Barrett, MD, PhD
Chair
Sunnybrook Health Science, University of Toronto
Toronto, ON, Canada
Eran Ashwal, MD
Clinical Fellow
McMaster University
North York, Tel Aviv, Canada
Doppler measurements play a crucial role in managing fetuses with impaired fetal growth. However, the existing evidence on their association with the mode of delivery is limited. This study aims to identify the sonographic parameters associated with intrapartum cesarean section among patients with small-for-gestational-age (SGA) or fetal growth-restricted (FGR) fetuses.
Study Design:
A retrospective cohort study was conducted, including all singleton pregnancies ≥ 32 wks that experienced a trial of labor. All cases completed Doppler assessment (umbilical artery pulsatility index (UA-PI) and middle cerebral artery (MCA) PI, and cerebroplacental (CPR) within 14 days before birth. Eligible fetuses had either EFW and/or AC < 10% for gestational age without known genetic or structural anomalies. The study compared patients who achieved a successful vaginal birth with those who ultimately underwent an intrapartum cesarean birth. Univariate and multivariable logistic regressions were utilized.
Results:
In total, 632 patients with SGA/FGR fetuses participated in a trial of labor. Among them, 519 (82.1%) had a vaginal birth, while 113 (17.9%) underwent intrapartum cesarean birth. Gestational age at the most recent ultrasound, ultrasound-to-birth interval, rates of EFW < 3%, and rates of umbilical artery PI >95% were comparable between the groups. The Doppler status was significantly associated with the mode of delivery (p< 0.001; Figure) Multivariable logistic regressions adjusted for parity, obesity, history of cesarean birth, hypertensive disorders, labor induction, and gestational age at birth identified several sonographic parameters associated with an intrapartum cesarean birth. These included AC < 3% (adjusted odds ratio 1.63; 95% confidence interval 1.03-2.58) and CPR < 5% centile (2.02; 1.28-3.19).
Conclusion:
Sonographic measurements have been found to be significantly associated with the mode of delivery in SGA/FGR fetuses. These findings highlight the importance for caregivers to consider those parameters when counseling the mode of delivery with patients who have SGA/FGR fetuses.