Factors associated with mode of delivery in large-for-gestational-age fetuses: a retrospective cohort study.

IF 1.6 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction Pub Date : 2025-10-04 DOI:10.1016/j.jogoh.2025.103047

Salomé Azeroual, Mohamed Dakin, Théo Joannes, Olivier Graesslin, René Gabriel, Benjamin Birene

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引用次数: 0

Abstract

Background: Large-for-gestational-age (LGA) fetuses are often associated with increased maternal and neonatal morbidity. Although suspicion of LGA can prompt closer surveillance and interventions such as labor induction, the actual impact on delivery outcomes and complications remains controversial.

Purpose: To assess maternal and fetal factors associated with the mode of delivery in pregnancies with LGA fetuses.

Basic procedures: Retrospective, single-center study (2018-2021) including term, singleton pregnancies with birthweight ≥ 90th percentile (AUDIPOG). Exclusion criteria were prior cesarean, multiples, preterm birth, non-cephalic presentation, planned cesarean, maternal request, or incomplete records. Primary outcome was mode of delivery. Multiple logistic regression was used.

Main findings: A total of 211 women met inclusion criteria. The rate of operative delivery (cesarean or instrumental vaginal birth) was 32.2% (68/211). In multiple logistic regression, nulliparity (OR 8.1, 95% CI 3.2-20.5, p < 0.001), induction of labor (OR 2.6, 95% CI 1.1-6.3, p = 0.035), greater gestational weight gain (OR 1.07 per kg, 95% CI 1.01-1.14, p = 0.021), and prenatal suspicion of macrosomia (EFW > 90th percentile at growth or third-trimester ultrasound, OR 2.9, 95% CI 1.2-7.1, p = 0.019) were independently associated with an increased risk of non-spontaneous birth. Maternal age, diabetes, and a history of LGA were not significantly associated after adjustment. Neonatal outcomes were favorable, with only one case of umbilical arterial pH < 7.00 (0.5%) and no severe traumatic complications.

Conclusions: In LGA pregnancies, nulliparity and suspected macrosomia were associated with higher rates of medical intervention, whereas induction and prior vaginal delivery favored spontaneous birth. Neonatal weight did not differ between delivery modes. These findings underscore the complexity of managing suspected LGA fetuses and the need for prospective multicenter studies to refine risk stratification.

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与大胎龄胎儿分娩方式相关的因素：一项回顾性队列研究。

背景：大胎龄（LGA）胎儿通常与母体和新生儿发病率增加有关。虽然对LGA的怀疑可以促使更密切的监测和干预措施，如引产，但对分娩结果和并发症的实际影响仍存在争议。目的：评估与LGA胎儿妊娠分娩方式相关的母胎因素。基本程序：回顾性、单中心研究（2018-2021），包括足月、单胎妊娠，出生体重≥90百分位（AUDIPOG）。排除标准为既往剖宫产、多胎、早产、非头位表现、计划剖宫产、产妇要求或记录不完整。主要结局是分娩方式。采用多元逻辑回归。主要发现：共有211名女性符合纳入标准。手术分娩（剖宫产或顺产）率为32.2%（68/211）。在多元logistic回归中，无产（OR 8.1, 95% CI 3.2-20.5, p < 0.001）、引产（OR 2.6, 95% CI 1.1-6.3, p = 0.035）、妊娠体重增加（OR 1.07 / kg, 95% CI 1.01-1.14, p = 0.021）和产前怀疑巨大儿（EFW bb0生长或妊娠晚期超声第90百分位，OR 2.9, 95% CI 1.2-7.1, p = 0.019）与非自然分娩风险增加独立相关。调整后，产妇年龄、糖尿病和LGA病史无显著相关。新生儿结局良好，仅有1例脐动脉pH < 7.00(0.5%)，无严重创伤性并发症。结论：在LGA妊娠中，无产和疑似巨大儿与较高的医疗干预率相关，而诱导和阴道分娩倾向于自然分娩。新生儿体重在分娩方式之间没有差异。这些发现强调了处理疑似LGA胎儿的复杂性，以及前瞻性多中心研究以完善风险分层的必要性。

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来源期刊

Journal of gynecology obstetrics and human reproduction Medicine-Obstetrics and Gynecology

CiteScore

3.70

自引率

5.30%

发文量

210

审稿时长

31 days

期刊介绍： Formerly known as Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Journal of Gynecology Obstetrics and Human Reproduction is the official Academic publication of the French College of Obstetricians and Gynecologists (Collège National des Gynécologues et Obstétriciens Français / CNGOF). J Gynecol Obstet Hum Reprod publishes monthly, in English, research papers and techniques in the fields of Gynecology, Obstetrics, Neonatology and Human Reproduction: (guest) editorials, original articles, reviews, updates, technical notes, case reports, letters to the editor and guidelines. Original works include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses.