Intrapartum fetal heart rate characteristics of nonanomalous fetuses with trisomy 21.

OBJECTIVE: To compare the intrapartum fetal heart rate (FHR) characteristics and selected birth outcomes of nonanomalous trisomy 21 (T21) fetuses to matched controls. STUDY DESIGN: Nonanomalous, non-growth-restricted T21 infants were identified and matched by gestational age to presumed euploid controls. We excluded women with scheduled cesarean deliveries and multiple gestations. The incidence of abnormal FHR patterns within 3 hours of delivery and birth outcomes were compared between T21 fetuses and controls. The presence of any abnormal FHR pattern was the primary outcome. Birth outcomes included 5-minute Apgar <7, neonatal intensive care unit admission, and cesarean delivery for fetal indications. RESULTS: Forty-four T21 infants and 44 controls were compared. Of the T21 infants, 83% were postnatally diagnosed. No significant differences were noted in the primary outcome (68% versus 59%, p = 0.37) or birth outcomes. CONCLUSION: T21 is not associated with an increased incidence of abnormal FHR patterns or adverse birth outcomes compared with presumed euploid fetuses.

Effect of cerclage on cesarean delivery.

We sought to estimate if there is an association between cerclage and cesarean delivery. We performed a retrospective cohort study of women with high-risk factors for preterm birth. Those with a cerclage were compared with those without. Outcomes included overall incidence of cesarean delivery and incidence of cesarean delivery secondary to labor arrest. We identified 724 women at high risk for preterm birth; 232 (32%) women had cerclage placement, and 492 (68%) did not. There was no significant difference in the overall incidence of cesarean delivery between the two groups (odds ratio 1.15; 95% confidence interval 0.81 to 1.63). When comparison was limited to women who underwent a cesarean section secondary to labor arrest, the incidence of cesarean delivery between the two groups remained nonsignificant (odds ratio 1.85; 95% confidence interval 0.97 to 3.53). Women with cerclage in the current pregnancy do not have a higher incidence of cesarean delivery secondary to arrest of labor.