Delivery planning for pregnancies with gastroschisis: findings from a prospective national registry - 29/07/15

Doi : 10.1016/j.ajog.2015.06.048

Alya Al-Kaff, MD ^a, Sarah C. MacDonald, SM ^a,^⁎ , Nancy Kent, MD ^a, Jason Burrows, MD ^a, Erik D. Skarsgard, MD ^b, Jennifer A. Hutcheon, PhD ^a
and the
Canadian Pediatric Surgery Network
^a Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
^b Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

^∗Corresponding author: Sarah MacDonald, SM.

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Abstract

Objective

The purpose of this study was to determine the influence of planned mode and planned timing of delivery on neonatal outcomes in infants with gastroschisis.

Study Design

Data from the Canadian Pediatric Surgery Network cohort were used to identify 519 fetuses with isolated gastroschisis who were delivered at all tertiary-level perinatal centers in Canada from 2005-2013 (n = 16). Neonatal outcomes (including length of stay, duration of total parenteral nutrition, and a composite of perinatal death or prolonged exclusive total parenteral nutrition) were compared according to the 32-week gestation planned mode and timing of delivery with the use of the multivariable quantile and logistic regression.

Results

Planned induction of labor was not associated with decreased length of stay (adjusted median difference, –2.6 days; 95% confidence interval [CI], –9.9 to 4.8), total parenteral nutrition duration (adjusted median difference, −0.2 days; 95% CI, –6.4 to 6.0), or risk of the composite adverse outcome (relative risk, 1.7; 95% CI, 0.1–3.2) compared with planned vaginal delivery after spontaneous onset of labor. Planned delivery at 36-37 weeks’ gestation was not associated with decreased length of stay (adjusted median difference, 5.9 days; 95% CI, –5.7 to 17.5), total parenteral nutrition duration (adjusted median difference, 3.2 days; 95% CI, –7.9 to 14.3), or risk of composite outcome (relative risk, 2.3; 95% CI, 0.8–5.4) compared with planned delivery at ≥38 weeks' gestation.

Conclusion

Infants with gastroschisis who were delivered after planned induction or planned delivery at 36-37 weeks’ gestation did not have significantly better neonatal outcomes than planned vaginal delivery after spontaneous onset of labor and planned delivery at ≥38 weeks' gestation.

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Key words : gastroschisis, labor induction, mode of delivery, timing of delivery

Plan

Materials and Methods

	The Canadian Pediatric Surgery Network is funded by the Canadian Institutes of Health Research (CIHR). J.A.H. is the recipient of a CIHR New Investigator Award and a Scholar Award from the Michael Smith Foundation for Health Research.
	Funders had no role in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
	The authors report no conflict of interest.
	Cite this article as: Al-Kaff A, MacDonald SC, Kent N, et al. Delivery planning for pregnancies with gastroschisis: findings from a prospective national registry. Am J Obstet Gynecol 2015;213:••••.