Induction of labour & neurodevelopmental outcome among small for gestational age fetuses with deranged cerebral hemodynamics : a cohort study
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
Small for gestational age (SGA) fetuses with deranged cerebral hemodynamics are at higher risk of suboptimal neurodevelopment during early years of life. Altered neurodevelopmental outcome (NDO) is because of fetal brain adaptation to preserve its basic functions. This deficit in NDO may worsen if these fetuses are given a trial of induction of labor (IOL) for their delivery in response to fetal distress. This study was conducted to see whether IOL is related with neurodevelopment in SGA fetuses. Methods: Neurodevelopmental scores were assessed in cohort of 100 infants & children between ages of 6 to 24 months using Ages & Stages Questionnaire (ASQ-3) at Aga Khan University Hospital (AKUH). These children were SGA fetuses who had deranged cerebral hemodynamics while in utero & delivered at AKUH. Information about IOL was extracted from past medical records of antenatal clinic. The induced & non-induced groups were assessed prospectively for 5 domains of NDO (gross motor, communication, fine motor, personal social & problem solving). The cumulative NDO scores were then analyzed via linear regression analysis to find out association with IOL adjusted for all other variables. Results: The analysis on these two SGA groups Induced group (n=54) and non-induced (n=46) revealed that induction of labor was not associated with neurodevelopment of child. As for those who were induced 13 co-efficient was 4.23 with a 95% CI (-15.9, 24.4) adjusting for all other variables, which revealed insignificant results. Conclusion: Induction of labor did not affect neurodevelopmental outcome during early years of life among prenatally identified SGA fetuses. However, gestational age and enrollment of child in daycare academy do have an effect overall functional development of brain, adjusting for other stimulating factors. This establishes a foundation for further research on larger sample sizes to confirm our study findings.
Dr, N. S. (2018). Induction of labour & neurodevelopmental outcome among small for gestational age fetuses with deranged cerebral hemodynamics : a cohort study (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.