Keywords
Cesarean Section
Vaginal Delivery
How to Cite
Abstract
Background: Gastroschisis is an abdominal wall birth defect. Objective: The aim of this study was to compare mortality and morbidity in neonates with gastroschisis delivered by normal vaginal delivery (NVD) and cesarean section (CS). Methodology: A Comparative study was conducted between 37 neonates with gastroschisis, among which 15 were delivered by NVD and 22 by CS in different hospitals in Iraq. Our studies were quantified and recruited clinical patient outcomes like neonatal mortality and morbidity. Results: Death in the neonatal period was significantly low in the CS group (4.5% vs. 20.0%, p=0.038). The CS group also had a lower rate of preterm delivery (40.9% vs. 73.3%), higher mean APGAR at 1 and 5 minutes, lower rate of low birth weight (36.4% vs. 66.7%), and significantly lower mean length of NICU stay (26.7 vs. 41.2 days, p<0.05). Morbidities like sepsis (13.6% vs. 40.0%) and total infection (18.2% vs. 46.7%) happened less frequently in the CS group. By 12-month follow-up, the CS group also scored significantly higher on all ITQOL quality-of-life questionnaire sections. Conclusion: The results of this study suggest that cesarean section delivery is associated with significantly reduced mortality and morbidity and improved quality of life in infants with gastroschisis compared with vaginal delivery.
References
1. Mills JA, Lin Y, Macnab YC, Skarsgard ED. Perinatal predictors of outcome in gastroschisis. Journal of Perinatology 2010; 30:809–813.
2. Tsai MH, Huang HR, Chu SM, Yang PH, Lien R. Clinical features of newborns with gastroschisis and outcomes of different initial interventions: primary closure versus staged repair. Pediatrics & Neonatology 2010; 51:320–325.
3. Risby K, Husby S, Qvist N, Jakobsen MS. High mortality among children with gastroschisis after the neonatal period: a long-term follow-up study. Journal of Pediatric Surgery 2017; 52:431–436.
4. Gamba P, Midrio P. Abdominal wall defects: prenatal diagnosis, newborn management, and long-term outcomes. Seminars in Pediatric Surgery 2014; 23:283–290.
5. Kong JY, Yeo KT, Abdel-Latif ME, Bajuk B, Holland AJ, Adams S, et al. Outcomes of infants with abdominal wall defects over 18 years. Journal of Pediatric Surgery 2016; 51:1644–1649.
6. Durfee SM, Downard CD, Benson CB, Wilson JM. Postnatal outcome of fetuses with the prenatal diagnosis of gastroschisis. Journal of Ultrasound in Medicine 2002; 21:269–274.
7. Kirollos DW, Abdel-Latif ME. Mode of delivery and outcomes of infants with gastroschisis: a meta-analysis of observational studies. Archives of Disease in Childhood - Fetal and Neonatal Edition 2018; 103:F355–F363.
8. Rossi AC, Prefumo F. Accuracy of ultrasonography at 11–14 weeks of gestation for detection of fetal structural anomalies: a systematic review. Obstetrics & Gynecology 2013; 122:1160–1167.
9. Prefumo F, Izzi C. Fetal abdominal wall defects. Best Practice & Research Clinical Obstetrics & Gynaecology 2014; 28:391–402.
10. Segel SY, Marder SJ, Parry S, Macones GA. Fetal abdominal wall defects and mode of delivery: a systematic review. Obstetrics & Gynecology 2001; 98:867–873.
11. Case AP, Colpitts LR, Langlois PH, Scheuerle AE. Prenatal diagnosis and cesarean section in a large, population-based birth defects registry. The Journal of Maternal-Fetal & Neonatal Medicine 2012; 25:395–402.
12. Allman R, Sousa J, Walker MW, Laughon MM, Spitzer AR, Clark RH. The epidemiology, prevalence, and hospital outcomes of infants with gastroschisis. Journal of Perinatology 2016; 36:901–905.
13. Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Neu J, Carson TL. What are optimal cesarean section rates in the U.S., and how do we get there? A review of evidence-based recommendations and interventions. Journal of Women's Health 2017; 26:1285–1291.
14. Baud D, Lausman A, Alfaraj MA, Seaward G, Kingdom J, Windrim R, et al. Expectant management compared with elective delivery at 37 weeks for gastroschisis. Obstetrics & Gynecology 2013; 121:990–998.
15. Abdel-Latif ME, Bolisetty S, Abeywardana S, Lui K. Mode of delivery and neonatal survival of infants with gastroschisis in Australia and New Zealand. Journal of Pediatric Surgery 2008; 43:1685–1690.
16. Landisch RM, Yin Z, Christensen M, Szabo A, Wagner AJ. Outcomes of gastroschisis early delivery: A systematic review and meta-analysis. Journal of Pediatric Surgery 2017; 52:1962–1971.
17. Erdogan D, Azili MN, Cavusoglu YH, Tuncer IS, Karaman I, Karaman A, et al. 11-year experience with gastroschisis: factors affecting mortality and morbidity. Iranian Journal of Pediatrics 2012; 22:339–343.
18. Miller E Evaluation of the Texas Birth Defects Registry: an active surveillance system. Birth Defects Research Part A Clinical and Molecular Teratology 2006; 76:787–792.
19. National Center on Birth Defects and Developmental Disabilities. Appendix A: ICD-9 and CDC/BPA codes. Teratology 2002; 66 Suppl 1:S218–219.
20. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379:2151–2161.
21. Kochanek KD, Murphy S, Xu J, Arias E. Mortality in the United States, 2016. NCHS Data Brief 2017:1–8.
22. American College of Obstetricians and Gynecologists. Obstetric care consensus No. 6: periviable birth. Obstetrics & Gynecology 2017; 130:e187–e199.
23. Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, et al. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. American Journal of Obstetrics & Gynecology 2016; 215:103 e101–103 e114.
24. Snyder CW, Biggio JR, Brinson P, Barnes LA, Bartle DT, Georgeson KE, et al. Effects of multidisciplinary prenatal care and delivery mode on gastroschisis outcomes. Journal of Pediatric Surgery 2011; 46:86–89.
25. Contemporary Clinical Trials 2015; 45:139–145.
26. Boutros J, Regier M, Skarsgard ED, Canadian Pediatric Surgery N. Is timing everything? The influence of gestational age, birth weight, route, and intent of delivery on outcome in gastroschisis. Journal of Pediatric Surgery 2009; 44:912–917.
27. Clark RH, Walker MW, Gauderer MW. Factors associated with mortality in neonates with gastroschisis. European Journal of Pediatric Surgery 2011; 21:21–24.
28. Snyder CW, Biggio JR, Brinson P, Barnes LA, Bartle DT, Georgeson KE, et al. Effects of multidisciplinary prenatal care and delivery mode on gastroschisis outcomes. Journal of Pediatric Surgery 2011; 46:86–89.