ArticleArchives of gynecology and obstetrics2026
Planned mode of delivery and neonatal outcomes in pregnancies complicated by late-onset fetal growth restriction: a retrospective cohort study.
Article in Archives of gynecology and obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFetal growth restriction (FGR) is a major contributor to perinatal morbidity and mortality. While guidelines address timing of delivery, the optimal mode-induction of labor (IOL) versus planned cesarean delivery (CD)-remains uncertain.
objectiveTo evaluate the association between planned mode of delivery and neonatal outcomes in pregnancies complicated by late onset FGR (LOFGR). STUDY
designWe conducted a retrospective cohort study at a tertiary Canadian center (2017-2022). Singleton pregnancies with LOFGR (> 34 weeks' gestation), defined by Society for Maternal-Fetal Medicine (SMFM) criteria, were eligible if the last ultrasound was within 14 days of delivery. Exclusions included spontaneous labor, delivery < 34 weeks, and contraindications to labor. Planned mode of delivery (IOL vs CD) was the exposure. Outcomes were classified as severe (perinatal death, 5-min Apgar < 4, umbilical arterial pH < 7.05, base deficit ≥ 12 mmol/L, hypoxic-ischemic encephalopathy/therapeutic hypothermia, grade III-IV intraventricular hemorrhage, necrotizing enterocolitis, sepsis, or invasive ventilation > 24 h) or moderate (NICU stay > 72 h, Apgar 4-6, pH 7.05-7.10, non-invasive respiratory support > 6-12 h, transient tachypnea, or brief resuscitation). Multivariable logistic regression adjusted for confounders. A prespecified subgroup applied the ISUOG criteria.
resultsOf 12,270 deliveries, 1,143 (9.3%) met SMFM criteria for LOFGR; 869 were eligible (192 planned CD, 677 IOL). Severe outcomes and moderate outcomes were more frequent after CD (23.4% vs 16.7%; p = 0.03 and 42.2% vs 31.2%; p < 0.01, respectively). IOL was associated with lower adjusted risk of severe outcomes (aOR 0.35; 95% CI 0.19-0.67) and moderate outcomes (aOR 0.43; 95% CI 0.24-0.76). Results were consistent using ISUOG criteria (aOR 0.33; 95% CI 0.17-0.62 and aOR 0.44; 95% CI 0.25-0.79, respectively) About 20% of induced patients required intrapartum CD.
conclusionsIOL was associated with reduced severe and moderate neonatal morbidity compared with planned CD. IOL represents a safe alternative when intrapartum surveillance and timely operative delivery are available.
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