Sonographic markers of increased fetal adiposity demonstrate an increased risk for Cesarean delivery

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dc.contributor.author Hehir, Mark P.
dc.contributor.author Burke, Naomi
dc.contributor.author Burke, Gerard J.
dc.contributor.author Turner, Michael
dc.contributor.author Breathnach, Fionnuala M.
dc.contributor.author McAuliffe, Fionnuala M.
dc.contributor.author Morrison, John J.
dc.contributor.author Dornan, Samina
dc.contributor.author Higgins, John R.
dc.contributor.author Cotter, Amanda
dc.contributor.author Geary, Michael P.
dc.contributor.author McParland, Peter
dc.contributor.author Daly, Sean
dc.contributor.author Cody, Fiona
dc.contributor.author Dicker, Patrick
dc.contributor.author Tully, Elizabeth
dc.contributor.author Malone, Fergal D.
dc.date.accessioned 2019-04-26T11:26:38Z
dc.date.available 2019-04-26T11:26:38Z
dc.date.issued 2019-03-18
dc.identifier.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 en
dc.identifier.issn 0960-7692
dc.identifier.uri http://hdl.handle.net/10468/7805
dc.identifier.doi 10.1002/uog.20263 en
dc.description.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. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher John Wiley & Sons, Inc. en
dc.relation.uri https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.20263
dc.rights © 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. en
dc.subject Adiposity en
dc.subject Cesarean delivery en
dc.subject Fetus en
dc.subject Sonography en
dc.title Sonographic markers of increased fetal adiposity demonstrate an increased risk for Cesarean delivery en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother John R Higgins, Obstetrics & Gynaecology, University College Cork, Cork, Ireland. +353-21-490-3000 Email: j.higgins@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2020-03-18
dc.date.updated 2019-03-27T10:03:46Z
dc.description.version Accepted Version en
dc.internal.rssid 479313252
dc.contributor.funder Health Research Board en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Ultrasound in Obstetrics and Gynecology en
dc.internal.copyrightchecked Yes
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress j.higgins@ucc.ie en
dc.internal.bibliocheck In press. Check vol / issue / page range. Amend citation as necessary. en
dc.identifier.eissn 1469-0705


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