Fetal abdominal wall defects and mode of delivery: A systematic review

OBJECTIVE: To determine whether there is sufficient evidence to support cesarean delivery over vaginal delivery in women carrying a fetus with an abdominal wall defect. DATA SOURCES: An OVID MEDLINE search of English language abstracts using medical subject heading terms "gastroschisis," "omphalocele," and "fetal abdominal wall defects" was performed. The generated list of articles was supplemented by a review of their bibliographies and the bibliographies of obstetric texts. STUDY SELECTION: A total of 27 peer-reviewed observational studies were identified, and 15 were included in the meta-analysis. Our primary inclusion criterion was the reporting of neonatal outcomes for infants with abdominal wall defects who delivered vaginally and who delivered by cesarean section. Studies were excluded if they were a case series or if neonatal outcomes could not be ascertained from the data presented in the manuscript. TABULATION, INTEGRATION, AND RESULTS: Standard meta-analytic techniques were applied to assess the question of whether cesarean delivery improves neonatal outcomes in infants with abdominal wall defects. There was no significant relationship between mode of delivery and the rate of primary fascial repair (random effects model: pooled relative risk [RR] 1.22, 95% confidence interval [CI] 0.99, 1.51), neonatal sepsis (random effects model: pooled RR 0.70, 95% CI 0.30, 1.62), or pediatric mortality (random effects model: pooled RR 1.14, 95% CI 0.59, 2.21). Additionally, there was no significant relationship between mode of delivery and time until enteral feeding or length of hospital stay. CONCLUSION: The available data do not provide evidence to support a policy of cesarean delivery for infants with abdominal wall defects.