Elective preterm birth for fetal gastroschisis.

Area of Science:

• Perinatal Medicine
• Neonatology
• Maternal-Fetal Medicine

Background:

• Gastroschisis is a congenital abdominal wall defect with potential for in-utero bowel injury.
• While most infants with gastroschisis survive, complications like necrotizing enterocolitis and prolonged intensive care occur.
• Early birth may reduce complications but risks prematurity-related issues.

Purpose of the Study:

• To evaluate the impact of planned preterm birth on pregnancies affected by fetal gastroschisis.
• To assess outcomes related to timing of delivery, not mode (vaginal vs. cesarean).

Main Methods:

• Searched the Cochrane Pregnancy and Childbirth Group's Trials Register.
• Included one randomized controlled trial (RCT) of planned preterm birth (before 37 weeks) versus planned later birth (at or after 37 weeks).
• Assessed trial quality and extracted data on neonatal and maternal outcomes.

Main Results:

• One underpowered RCT with 40 infants/42 women was included.
• No significant benefits or adverse effects of elective preterm birth at 36 weeks were observed.
• Neonatal survival to discharge showed a non-significant trend towards harm in the elective preterm group (RR 5.00; 95% CI 0.26-98.00).

Conclusions:

• The review cannot draw firm conclusions on the benefits or harms of preterm birth for gastroschisis.
• The single included trial was too small to detect meaningful differences.
• Further research is essential to guide clinical practice regarding delivery timing for gastroschisis.