Suspected Fetal Compromise: Is Deferred Delivery Best?

When fetal compromise is suspected, deferring delivery to allow the fetus more time in the womb until test results worsen or a favorable gestational age has been achieved may improve fetal and maternal outcomes, concluded a new study.¹ Fetal compromise can be difficult to assess, and most cases have no obvious cause; these factors make management incredibly challenging.

The aim of management is optimal timing of delivery. The choices are immediate delivery or deferred delivery. Choosing immediate delivery increases risks of adverse effects associated with prematurity, such as respiratory distress, hypothermia, hypoglycemia, infection, and jaundice. Whereas deferred delivery risks damage to vital organs because of insufficient oxygen or nutrients in the womb.

Using data from a study that included 548 pregnant women and 588 infants with a gestational age between 24 and 36 weeks, researchers assessed neonatal, maternal, and long-term outcomes associated with immediate versus deferred delivery of preterm infants with suspected fetal compromise. The median time between randomization and delivery in the study groups was 4 days.

Compared with the deferred delivery group, Cesarean delivery occurred more often and more neonates required mechanical ventilation for 24 hours or longer in the immediate delivery group. No differences in the rates of extended perinatal mortality or of death or disability at or after 2 years were found between study groups. Also similar between the study groups were the rates of neonatal morbidity or markers of neonatal morbidity, such as a cord pH level of less than 7.00, an Apgar score of less than 7 at 5 minutes, convulsions, interventricular hemorrhage, germinal matrix hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, or ventriculomegaly.

In terms of long-term outcomes, more children aged 2 years or older had cerebral palsy in the immediate delivery group than in the deferred delivery group. However, the rates of impaired neurodevelopment at or after 2 years of age and the rates of death or disability in children aged 6 to 13 years were similar between groups.

There is not enough evidence on the benefits and harms of immediate versus deferred delivery in cases of suspected fetal compromise to make firm recommendations that direct clinical practice, but these findings show that there is no obvious benefit to immediate delivery.

Pertinent Points:
- Deferred delivery may be more beneficial to both the mother and the infant in cases in which fetal compromise is suspected.
- More research is needed to confirm these findings and to ascertain whether there are any differences in neonatal deaths between immediate and deferred delivery types.