Factors Associated with Cesarean Delivery Due to Intrapartum Fetal Compromise in Late-Onset Fetal Growth Restriction: A Retrospective Cohort Study

Objective: To investigate clinical, ultrasonographic, and hematological factors associated with cesarean delivery due to intrapartum fetal compromise in pregnancies complicated by isolated late-onset fetal growth restriction (FGR) undergoing induction of labor at 37 weeks of gestation. Methods: This retrospective cohort study included singleton pregnancies with isolated late-onset FGR undergoing elective induction of labor between 37 + 0 and 37 + 6 weeks of gestation. Patients who underwent cesarean delivery due to intrapartum fetal compromise constituted the study group (n = 44), whereas those who achieved vaginal delivery formed the control group (n = 100). Maternal demographic characteristics, fetal ultrasonographic findings, and systemic inflammatory indices were evaluated. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results: Gravidity, parity, induction-to-birth interval, cervical dilatation at admission, femur length, and platelet count differed significantly between the groups. In multivariable logistic regression analysis, parity remained the only independent predictor of cesarean delivery due to intrapartum fetal compromise (adjusted OR 0.421, 95% CI 0.191–0.926, p = 0.031). Systemic inflammatory indices and most fetal ultrasonographic parameters did not demonstrate independent predictive value. The combined multivariable model demonstrated acceptable discriminative performance (AUC 0.731, 95% CI 0.636–0.827, p < 0.001). Neonatal outcomes were comparable between the groups. Conclusions: In pregnancies complicated by isolated late-onset FGR undergoing induction of labor at 37 weeks, parity was the only independent predictor of cesarean delivery due to intrapartum fetal compromise. Routine clinical, ultrasonographic, and hematological inflammatory markers demonstrated limited independent predictive value. These findings suggest that intrapartum fetal compromise in FGR pregnancies may primarily reflect reduced fetoplacental reserve rather than isolated antenatal parameters.