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Expectant management compared with elective delivery at 37 weeks for gastroschisis
David Baud1, Andrea Lausman, Malikah A Alfaraj
1Fetal Medicine Unit and the Department of Paediatrics, Mount Sinai Hospital, the Department of Paediatric Surgery, Hospital for Sick Children, and the University of Toronto, Toronto, Ontario, Canada.
Obstetrics and Gynecology
|May 3, 2013
Summary
Induction of labor at 37 weeks gestation for fetal gastroschisis reduces neonatal sepsis and bowel damage risks. This approach also shortens hospital stays and improves feeding outcomes compared to expectant management.
Area of Science:
- Perinatal medicine
- Neonatal surgery
- Maternal-fetal medicine
Background:
- Gastroschisis is a congenital abdominal wall defect with significant neonatal morbidity.
- Optimal timing of delivery for gastroschisis remains a topic of clinical debate.
- Current management strategies involve close fetal surveillance and timely intervention.
Purpose of the Study:
- To compare obstetric and neonatal outcomes in pregnancies with fetal gastroschisis.
- To evaluate the impact of labor induction at 37 weeks gestation versus expectant management.
- To assess risks of neonatal complications and resource utilization.
Main Methods:
- Retrospective review of 296 pregnancies with fetal gastroschisis (1980-2011).
- Intensive fetal surveillance including ultrasound and nonstress testing.
- Analysis of outcomes based on induction of labor at 37 weeks versus expectant management.
Main Results:
- Induction of labor at 37 weeks was associated with significantly lower rates of neonatal sepsis (25% vs 42%).
- Composite outcomes of neonatal death and bowel damage were reduced in the induced group (8% vs 21%).
- Expectant management led to longer durations for oral feeds, total parenteral nutrition, and hospital stay.
Conclusions:
- Induction of labor at 37 weeks gestation is a beneficial strategy for pregnancies complicated by fetal gastroschisis.
- This approach is linked to decreased neonatal sepsis, bowel damage, and mortality.
- Early induction can lead to improved neonatal outcomes and reduced healthcare resource utilization.
