Neonatal outcomes and Cesarean delivery in pregnancies complicated by IUGR with abnormal umbilical artery Doppler: A global systematic review and Meta-analysis

Intrauterine growth restriction (IUGR) is a condition characterized by fetal growth below the 10th percentile for gestational age, often associated with adverse perinatal outcomes. Abnormal umbilical artery Doppler findings, such as reduced or absent end-diastolic flow, are frequently observed in IUGR pregnancies and are indicative of placental insufficiency. This systematic review and meta -analysis aim to estimate the pooled rates of cesarean delivery, low APGAR score, and various neonatal complications based on global literature. This systematic review and meta -analysis (SRMA) adhered to PRISMA guidelines. A comprehensive search was conducted across international databases, including PubMed, Google Scholar, PsycINFO, ScienceDirect, Web of Science, and African Online Journals, using PICO-based search terms. Duplicates were removed with EndNote X20 software, and data were organized in Microsoft Excel. Pooled estimates were calculated using a weighted inverse variance random-effects model. Heterogeneity was assessed with the Cochrane Q-test and I2 statistics, and publication bias was examined using a funnel plot and Egger’s test. All analyses were performed using Stata version 17. A total of 1003 records were identified, with 31 studies included in the final analysis. The pooled cesarean section rate was 68.82 % (95 % CI: 57.61 %–80.02 %), and 31.18 % of neonates had low APGAR scores (95 % CI: 20.20 %–42.17 %). The prevalence of birth asphyxia was 20.27 % (95 % CI: 7.05–33.5 %), and 41.04 % of neonates required positive pressure ventilation (PPV) (95 % CI: 21.18–60.90 %). Respiratory distress syndrome (RDS) occurred in 51.95 % (95 % CI: 32.99–70.92 %), neonatal sepsis in 27.39 % (95 % CI: 15.38–39.40 %), intraventricular hemorrhage (IVH) in 10.75 % (95 % CI: 6.81–14.7 %), and necrotizing enterocolitis (NEC) in 10.07 % (95 % CI: 5.13–15.01 %). The pooled estimates demonstrated significantly elevated rates of low APGAR scores at the 5th minute, birth asphyxia, neonatal sepsis, respiratory distress syndrome, positive pressure ventilation requirement, intraventricular hemorrhage, and necrotizing enterocolitis. Additionally, the cesarean delivery rate was notably high at 68.82 %.