The fetus with gastroschisis managed by a trial of labor: Antepartum and intrapartum complications

OBJECTIVE: To assess the rate of antepartum and intrapartum complications of fetuses with antenatally diagnosed gastroschisis managed in a center that advocates a trial of labor. STUDY DESIGN: A retrospective review. The medical records of 49 fetuses (1988 to 1997) who were prenatally diagnosed with gastroschisis by a sonologist in the Ultrasound Genetic Unit, Department of Obstetrics and Gynecology at Washington University, were reviewed. RESULTS: Oligohydramnios and intrauterine growth restriction were diagnosed in 23% and 49% of the pregnancies, respectively. A total of 22 women underwent induction of labor nine for nonreassuring fetal testing, four for premature rupture of membranes, five for marked bowel dilatation, one forpreedampsia, and three for other reasons. Cesarean section (CS) was performed in 16 of 43 (37%) of women. The indications for CS were fetal distress (9 of 16 women), chorioamnionitis (2 of 16 women), breech presentation (3 of 16 women), and physician discretion (2 of 16 women). No significant differences in Apgar scores were observed between the fetuses. Fetuses who were delivered by CS for fetal distress were more likely to have undergone an induction of labor (91% versus 44%), and they were smaller than fetuses with no evidence of fetal distress (2220 ± 105 gm versus 2613 ± 80 gm, p<0.05). CONCLUSION: The incidence of antepartum and intrapartum complications in fetuses with gastroschisis is high. The rate of CS can reach 37%. These data may aid clinicians in counseling patients with gastroschisis.