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Cesarean section does not improve outcome in gastroschisis.
C A Bethel1, J H Seashore, R J Touloukian
1Department of Surgery, Yale University School of Medicine, New Haven, CT 06510.
Journal of Pediatric Surgery
|January 1, 1989
Summary
Elective cesarean section (CS) for gastroschisis does not improve infant outcomes. This study found no significant differences in mortality or complications between vaginal and CS deliveries for this condition.
Area of Science:
- Perinatal medicine
- Neonatal surgery
- Obstetrics
Background:
- Prenatal diagnosis of gastroschisis has led to recommendations for elective cesarean sections (CS).
- The hypothesis that CS reduces morbidity and mortality in gastroschisis cases needs evaluation.
Purpose of the Study:
- To examine the impact of delivery mode on outcomes for infants with prenatally diagnosed gastroschisis.
- To determine if elective CS offers advantages over vaginal delivery.
Main Methods:
- Retrospective review of 28 consecutive gastroschisis cases (1975-1987).
- Comparison of outcomes between infants delivered vaginally (n=14) and by CS (n=14).
- Analysis included gestational age, birth weight, Apgar scores, mortality, complications, and hospital stay.
Main Results:
- No significant differences in mortality, complications, days to enteral feeding, or hospital stay between vaginal and CS groups.
- One vaginal delivery case had a preventable mesenteric avulsion; CS infants were slightly more likely to have primary closure (not statistically significant).
- Elective CS in seven prenatally diagnosed cases did not improve outcomes, with low primary closure rates and complications.
Conclusions:
- Cesarean section should not be routinely recommended solely based on a prenatal diagnosis of gastroschisis.
- Current data suggest no significant benefit in morbidity or mortality with CS delivery for gastroschisis.
- Mode of delivery does not appear to be a critical factor in gastroschisis management outcomes.