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Omphalocele delivery enigma: the best mode of delivery still remains dubious
S Lurie1, D Sherman, I Bukovsky
1Department of Obstetrics and Gynecology, Assaf-Harofeh Medical Center, Zerifin, Israel.
Objective:
To determine an optimal route of delivery for fetuses with prenatally diagnosed omphalocele.
Data Source:
MEDLINE search of years 1966-1996.
Results:
Descriptive retrospective analyses do not support the idea that cesarean delivery of fetuses with omphalocele is associated with an improved survival rate. However, most of those studies do not control for confounding variables like type and severity of associated anomalies, omphalocele size, prematurity rate, presence of trial of vaginal delivery, rate of intrapartum sac rupture, tertiary treatment centers accessibility, time and type of surgical correction, and postoperative morbidity. There is no evidence that vaginal delivery is safer than cesarean for fetuses with isolated small omphalocele. Fetuses with giant (>5 cm) omphalocele should be delivered by cesarean section. Vaginal delivery at term is offered for fetuses with coexisting life-threatening anomalies.
Conclusions:
We propose that until randomized trial of vaginal and cesarean delivery for fetal omphalocele is available, the preferred mode of delivery would be the vaginal route as that is safer for the mother.