Study details cesarean use in life-limiting fetal diagnosis cases

A retrospective cohort study published in Pregnancy examined the proportion and clinical indications for cesarean delivery (CD) among patients carrying a life-limiting fetal diagnosis (LLFD). The study aimed to characterize a higher rate of CD previously reported in the literature for conditions such as anencephaly and trisomy 18, and to clarify the clinical indications driving that pattern.

The cohort included patients with an antenatal LLFD who delivered at a tertiary care center between January 1, 2018, and May 1, 2025, at or beyond 24 weeks' gestation. LLFD cases were identified through manual review by Maternal-Fetal Medicine and Neonatology subspecialists and restricted to 6 prespecified diagnoses: anencephaly, trisomy 13, trisomy 18, anhydramnios due to genitourinary etiologies, limb-body wall complex, and severe skeletal dysplasia. The primary outcome was CD; the secondary outcome was indication for CD.

Key data

• 32,523 deliveries were screened for eligibility; 241 were identified as having an antenatal LLFD
• After restriction to the 6 prespecified diagnoses, the final cohort included 106 patients
• CD occurred in 42.5% of LLFD pregnancies overall
• CD rate by diagnosis: 0% in anencephaly, 36.4% in skeletal dysplasia, 40.0% in trisomy 13, 45.8% in trisomy 18, 40.0% in limb-body wall complex, and 54.5% in anhydramnios due to a genitourinary cause
• 53.3% of CDs were performed for a fetal indication, most commonly malpresentation and non-reassuring fetal status

CD rates varied widely across diagnoses

The overall 42.5% CD rate masked substantial variation by underlying diagnosis, ranging from no cesarean deliveries among patients with anencephaly to a majority-cesarean rate among those with anhydramnios due to a genitourinary cause. This spread suggests that diagnosis-specific clinical factors, rather than a uniform approach to LLFD pregnancies, shape delivery mode decisions.

Fetal indications accounted for the majority of cesarean deliveries

Just over half of cesarean deliveries in the cohort were performed for a fetal indication, led by malpresentation and non-reassuring fetal status, the same indications traditionally used in pregnancies without a life-limiting diagnosis.

“It is unclear whether the increased proportion of CD is driven by traditional obstetric indications or patient-centered choices regarding the delivery experience,” wrote the authors in conclusion.

Reference:

Petrie HC, Sundermann AC, Hamilton BW, McCarthy AM, Morris EA, Gatta LA. Indications for cesarean delivery among patients with life‐limiting fetal diagnoses. Pregnancy. 2026;2(5):e70429. doi:10.1002/pmf2.70429