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Sonographic markers of increased fetal adiposity demonstrate an increased risk for Cesarean delivery
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Date
2019-03-18
Authors
Hehir, Mark P.
Burke, Naomi
Burke, Gerard J.
Turner, Michael
Breathnach, Fionnuala M.
McAuliffe, Fionnuala M.
Morrison, John J.
Dornan, Samina
Higgins, John R.
Cotter, Amanda
Journal Title
Journal ISSN
Volume Title
Publisher
John Wiley & Sons, Inc.
Published Version
Abstract
OBJECTIVE: Increased fetal size is associated with labor dystocia and subsequent need for assisted delivery. We sought to investigate if increased fetal adiposity diagnosed sonographically was associated with increased risk of operative delivery. METHOD: The Genesis Study recruited 2,392 nulliparous patients with a vertex presentation in a prospective multicenter study to examine prenatal and intra‐partum predictors of cesarean delivery. Participants had ultrasound and clinical evaluation performed between 39 0/7 and 40 6/7 weeks’ gestation. Data on fetal biometry was not revealed either to patients or their managing clinicians. A fetal adiposity composite of fetal thigh adiposity and fetal abdominal thickness was compiled for each infant in order to clarify if fetal adiposity >90th centile was associated with an increased risk of cesarean or instrumental delivery. RESULTS: After exclusions data were available for 2,330 patients. Patients with a fetal adiposity composite >90th centile had a higher maternal BMI (24±4 vs. 25±5; p=0.005), birthweight (3872 ± 417g vs. 3585 ± 401g; p<0.0001) and rate of induction of labor (47% [108/232] vs. 40% [834/2098]; p=0.048) than those patients with an adiposity composite ≤90th centile. Fetuses with adiposity composite >90th centile were more likely to require cesarean delivery than fetuses with adiposity <90th centile (p<0.0001). After adjusting for birthweight, maternal BMI, and onset of labor, fetal adiposity >90th centile remained a risk factor for cesarean delivery (p<0.0001). A fetal adiposity composite >90th centile was found to be more predictive of the need for unplanned cesarean delivery than an estimated fetal weight >90th centile (OR= 2.20 [95% CI: 1.65 – 2.94; p<0.001] vs. OR=1.74 [1.29 – 2.35, p<0.001]. Having a composite adiposity >90th centile was not found to be associated with an increased likelihood of operative vaginal delivery when compared with fetuses <90th centile (p=0.37). CONCLUSION: Fetuses with increased adipose deposition were more likely to require cesarean delivery. Given that increased fetal adiposity is a risk factor for cesarean delivery, consideration should be given to adding fetal thigh and abdominal wall thickness to fetal sonographic assessment in late pregnancy.
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Keywords
Adiposity , Cesarean delivery , Fetus , Sonography
Citation
Hehir, M. P., Burke, N., Burke, G.,Turner, M., Breathnach, F. M., McAuliffe, F. M., Morrison, J. J., Dornan, S., Higgins, J., Cotter, A., Geary, M. P., McParland, P., Daly, S., Cody, F., Dicker, P., Tully, E. and Malone, F. D. (2019) 'Sonographic markers of increased fetal adiposity demonstrate an increased risk for Cesarean delivery', Ultrasound in Obstetrics and Gynecology. doi: 10.1002/uog.20263
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Copyright
© 2019, John Wiley & Sons Inc. This is the peer reviewed version of the following article: Hehir, M. P., Burke, N., Burke, G.,Turner, M., Breathnach, F. M., McAuliffe, F. M., Morrison, J. J., Dornan, S., Higgins, J., Cotter, A., Geary, M. P., McParland, P., Daly, S., Cody, F., Dicker, P., Tully, E. and Malone, F. D. (2019) 'Sonographic markers of increased fetal adiposity demonstrate an increased risk for Cesarean delivery', Ultrasound in Obstetrics and Gynecology. doi: 10.1002/uog.20263, which has been published in final form at https://doi.org/10.1002/uog.20263. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.