Mode of Delivery and Perinatal Outcomes in Pregnancies With Absent End-Diastolic Flow: A Prospective Observational...

Background Absent end-diastolic flow (AEDF) in the umbilical artery depicts an advanced stage of placental insufficiency. It is often associated with significant perinatal morbidity and mortality. While cesarean delivery is preferred, the evidence guiding the optimal mode of delivery remains limited. Methods This prospective observational study included 71 singleton pregnancies beyond 28 weeks with AEDF. Maternal, fetal, and delivery characteristics were recorded. The primary outcome was a composite perinatal outcome comprising cord pH <7.1, five-minute Apgar score <7, feeding intolerance, sepsis, necrotizing enterocolitis, or neonatal mortality. Results Overall, cesarean section was performed in 58 (81.7%) of cases. Of these, 33 underwent direct cesarean delivery without an attempted labor (categories 1 and 2), while 12 had elective surgery (categories 3 and 4). A trial of labor was attempted in 26 women, and 13 (50%) achieved vaginal deliveries. Adverse composite perinatal outcomes (APOs) occurred in 37 (52%) of the neonates, with 9 neonatal deaths. Lower birth weight and gestational age were significantly associated with adverse outcomes. Birth weight was an independent predictor in the multivariate analysis, whereas gestational age, duration of AEDF, and mode of delivery were not. Conclusion Perinatal outcomes in AEDF pregnancies are primarily influenced by birth weight. Mode of delivery did not independently affect adverse perinatal outcomes. A carefully selected trial of labor may be considered in appropriate clinical settings. Future adequately powered prospective comparative studies are needed to clarify the optimal mode of delivery in pregnancies complicated by AEDF.