DEV MAULIK, MD, PHD GENEVIEVE SICURANZA, MD ANDREZJ LYSIKIEWICZ, MD, PHD REINALDO FIGUEROA, MD Dr. Maulik is chairman, department of obstetrics and gynecology, Winthrop-University Hospital, Mineola, NY, and professor of obstetrics and gynecology, State University of New York, Stony Brook, NY. Dr. Sicuranza is chief of obstetrics and director of maternal-fetal medicine, department of obstetrics and gynecology, Winthrop-University Hospital, Mineola, NY, and associate professor of obstetrics and gynecology, State University of New York, Stony Brook, NY. Dr. Lysikiewicz is director of obstetrical and gynecological ultrasound services, department of obstetrics and gynecology, Winthrop-University Hospital, Mineola, NY, and professor of obstetrics and gynecology, State University of New York, Stony Brook, NY. Dr. Figueroa is director of graduate education, department of obstetrics and gynecology, Winthrop-University Hospital, Mineola, NY, and associate professor of obstetrics and gynecology, State University of New York, Stony Brook, NY.
Labor and delivery of growth-restricted infants often is associated with a higher risk of asphyxia. The frequency of nonreassuring fetal heart rate patterns is increased. In addition, because of the greater prevalence of oligohydramnios, cord compression is frequent and associated with variable decelerations. There also is an increased risk of neonatal morbidities, as discussed above. Because of these risks, the growth-restricted fetus should be delivered in a facility that can offer appropriate inhouse support services such as neonatology and anesthesia.
If the patient is allowed to labor, use continuous electronic fetal heart rate monitoring with vigilance and perform the appropriate secondary tests, such as fetal scalp sampling or scalp stimulation. The ability of a growth-restricted fetus to tolerate labor is likely very limited.
Any confirmed signs of fetal compromise indicate cesarean as the optimal mode of delivery.
The authors report no financial relationships relevant to this article.
