title: Fetal growth restriction: risk factors for unplanned primary cesarean delivery.
abstract: OBJECTIVE
  The purpose of this study was to identify risk factors before or during labor to predict primary cesarean delivery for non-reassuring fetal heart tracing in cases of fetal growth restriction (FGR) undergoing a trial of labor.
  
  
  METHODS
  We reviewed charts of all patients with singleton, non-anomalous fetuses found to have FGR and delivered from January 2008 to December 2012. Characteristics of patients delivered by cesarean were compared to those who had delivered vaginally.
  
  
  RESULTS
  Two hundred and twenty-two patients were delivered with FGR. Fifty-nine patients were excluded due to cesarean delivery prior to labor. Of the remaining 153 patients, 84% delivered vaginally and 16% underwent cesarean delivery. Of the 131 patients who underwent induction, 83% delivered vaginally. Rates of cesarean were higher for primigravity, oligohydramnios and prostaglandin use. However, logistic regression showed that oligohydramnios (odds ratio [OR]: 3.98; CI: 1.35-11.76) and prostaglandin use (OR: 3.67; CI: 1.07-12.60) were significantly associated with cesarean delivery.
  
  
  CONCLUSIONS
  The rate of vaginal delivery is high in cases of FGR undergoing a trial of labor. We recommend that these patients undergo a trial of labor. Patients with oligohydramnios and those requiring prostaglandins for cervical ripening should be counseled regarding a significantly higher risk of cesarean delivery.
authors.affiliation: a Department of Maternal-Fetal Medicine , University of Connecticut Health Center , Farmington , CT , USA and.
authors.forename: Kari M
authors.initials: KM
authors.lastname: Horowitz
authors.affiliation: b Department of Maternal-Fetal Medicine , Hartford Hospital , Hartford , CT , USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Feldman
mesh_terms: D002585:Cesarean Section; D005260:Female; D005316:Fetal Distress / Q000209:etiology / Q000601:surgery*; D005317:Fetal Growth Retardation; D006801:Humans; D007751:Labor, Induced; D016015:Logistic Models; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Cesarean delivery; fetal growth restriction; induction