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Gautier EJD, Thorsteinsson-Burlin A, Storme L, Garabedian C, Debarge V, Subtil D. [Risk of neonatal acidosis in preterm induction of labor for fetal growth restriction]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00190-9. [PMID: 38583711 DOI: 10.1016/j.gofs.2024.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE If a small for gestational age (SGA) foetus needs to be delivered because of severity (< 3rd centile) attempting induction of labor theoretically increases the risk of caesarean section and neonatal acidosis, but these risks are poorly understood. This article aims to assess the risk of caesarean section and neonatal acidosis in attempted vaginal birth of a moderately preterm foetus in the setting of severe SGA. METHOD A single-centre hospital-based observational study conducted over a period of 17 consecutive years in mothers with a single foetus in cephalic presentation with severe SGA (< 3rd centile) needing foetal extraction. Neonatal acidosis was considered moderate if pH<7.10 and severe if pH<7.0. The degree of severity of SGA was estimated according to the birth weight ratio. RESULTS Four hundred and thirty-fourfoetuses with severe SGA were included during the period, 140 of whom were born after induction (32.3%). In this group, 66.4 % of women achieved a vaginal birth (66.4% CI95[58.0-74.2]) and the risk of moderate or severe acidosis was doubled compared with the group of foetuses who had undergone a planned caesarean section (7.9% vs 3.1%, OR=2.7 [1.1-6.7]). Neither gestational age nor the degree of growth restriction was significantly related to the risk of caesarean section or to the risk of moderate or severe neonatal acidosis Conclusion: In cases of severe SGA before 37 weeks' gestation, induction of labour allows vaginal delivery in two-thirds of cases. It is accompanied by a doubling of the risk of moderate or severe neonatal acidosis.
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Affiliation(s)
- Estelle Jean Dit Gautier
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, F-59000 Lille, France
| | | | - Laurent Storme
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR2694, METRICS, Evaluation of health technologies and medical practices, F-59000 Lille, France
| | - Charles Garabedian
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR2694, METRICS, Evaluation of health technologies and medical practices, F-59000 Lille, France
| | - Véronique Debarge
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, F-59000 Lille, France
| | - Damien Subtil
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR2694, METRICS, Evaluation of health technologies and medical practices, F-59000 Lille, France
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