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Fetus

Poster Session 3

(745) Mode of delivery in FGR by EFW<10% vs. EFW≥10%ile and AC<10%ile undergoing trial of labor

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Henri M. Rosenberg, MD

MFM Fellow
Mount Sinai Medical Center
New York, NY, United States

Coauthor(s)

Alexandra N. Mills, BS (she/her/hers)

Medical Student
Icahn School of Medicine at Mount Sinai
New York, NY, United States
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Ana Çapi, MD

Mount Sinai Hospital
New York, NY, United States
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Elianna Kaplowitz, MPH

Mount Sinai Hospital
New York, NY, United States
Daniel Kuhr, MD

Resident Physician
Mount Sinai Hospital
New York, NY, United States
Sara Edwards, MD (she/her/hers)

Maternal-Fetal Medicine Fellow
Icahn School of Medicine at Mount Sinai
New York, NY, United States
Calvin E. Lambert, Jr., MD

Maternal Fetal Medicine
Icahn School of Medicine at Mount Sinai
Richmond Hill, NY, United States
AB

Angela Bianco, MD

Attending Physician
Mount Sinai Medical Center
New York, NY, United States
Chelsea A. DeBolt, MD

MFM Fellow
Mount Sinai Hospital
New York, NY, United States

Objective: Per 2020 SMFM guidelines, fetal growth restriction (FGR) is diagnosed by estimated fetal weight (EFW) < 10%ile or abdominal circumference (AC) < 10%ile despite EFW. The objective was to investigate the difference in mode of delivery in patients undergoing a trial of labor between EFW < 10%ile versus AC< 10%ile but EFW ≥10%ile.

Study Design: Retrospective cohort study including singleton, non-anomalous gestation, diagnosed with FGR prior to delivery undergoing trial of labor at Mount Sinai Hospital from 2021-2023. Patient characteristics were compared between groups using T-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher’s exact tests for categorical measures. Primary outcome was mode of delivery. Primary and secondary outcomes were assessed using univariable and multivariable logistic regression, controlling for gestational age at delivery.

Results: 141 patients (65%) were diagnosed with FGR based on EFW < 10%ile and 77 (35%) were diagnosed with FGR based on EFW ≥10%ile and AC < 10%ile. Those with EFW < 10%ile were more likely to have hypertensive disorders of pregnancy (p=0.03) and early onset FGR (p=0.003). The mean gestational age at delivery was 37 weeks versus 39 weeks for those with EFW < 10%ile compared to EFW ≥10%ile (p< 0.0001). There were no differences in the remaining maternal characteristics, including nulliparity and induction of labor. Overall cesarean delivery (CD) rate was 17.4%. There was no significant difference in CD rate in fetuses with EFW < 10%ile vs. EFW ≥10%ile and AC < 10%ile (aOR 0.90, 0.7-1.1). Those with EFW < 10%ile were at increased odds of CD for non-reassuring fetal status compared to those with EFW ≥10%ile and AC < 10%ile (OR 6.8, 1.6-29.8) and increased odds of NICU admission (OR 3.1, 1.2-7.7, Table 1).

Conclusion: There does not appear to be increased odds of CD in pregnancies complicated by FGR based on diagnostic parameters. However, future studies with larger sample sizes are warranted.