Routine Cesarean Delivery Does Not Improve the Outcome of Infants With Gastroschisis

ABSTRACT The incidence of gastroschisis has increased with the wider use of prenatal ultrasound scanning. The best mode of delivery for these infants still is debated. Although proponents of routine cesarean section (CS) claim less gastrointestinal morbidity and fewer complications, there is evidence that infants delivered vaginally have equivalent outcomes. This retrospective study compared CS with vaginal delivery (VD) in infants with gastroschisis who were seen at 2 tertiary care pediatric centers in the years 1990–2000. The 113 participants included 82 in the VD group and 31 having CS delivery. Gestational ages and birth weights were similar in the 2 groups. Rates of preterm induction of labor, atresia, and mortality were comparable. Neither the rate of primary closure nor the average number of surgeries differed significantly. The groups were similar in parameters of feeding: days with nothing by mouth, days on total parenteral nutrition, and time to full feeding. Both respiratory distress at birth and bowel stenosis were significantly more frequent in the CS group, but no such trend was seen for necrotizing enterocolitis, intestinal perforation, or ischemia. An increased incidence of intestinal stenosis in the CS group persisted after eliminating infants born by CS because of fetal distress. In the overall group, CS was an independent predictor of respiratory distress at birth, gastrointestinal dysfunction, and intestinal stenosis. The respective odds ratios were 5.5, 5.6, and 7.6. CS was not an independent predictor of a longer hospital stay. Because infants with gastroschisis may have significant morbidity and mortality, they should be cared for at a tertiary care setting. The benefits of CS delivery must be weighed against an increased risk of respiratory distress at birth as well as gastrointestinal dysfunction. CS nevertheless may be necessary if fetal distress is present.