THE FETUS WITH GASTROSCHISIS - IMPACT OF ROUTE OF DELIVERY AND PRENATAL ULTRASONOGRAPHY

OBJECTIVES: Our purpose was (1) to assess the influence of delivery ro ute on neonatal outcome in fetuses with gastroschisis and (2) to corre late ultrasonographic appearance of fetal bowel with immediate postnat al ourcome. STUDY DESIGN: Forty-seven cases (1986 to 1994) were review ed; three abortions and two stillbirths were excluded. Ultrasonographi c appearance of fetal bowel (small bowel dilatation >10 mm) was evalua ted in 27 cases. RESULTS: Twenty-six infants (61.9%) were delivered va ginally and 16(38.1%) by cesarean section (11 elective, 5 in labor). D elivery route was not significantly associated with indicators of neon atal outcome (rate of primary closure, postoperative complications, da ys of parenteral nutrition, days to oral feeding, hospital days, or mo rtality). When ultrasonographic appearance of fetal bowel was correlat ed with outcome, fetuses with prenatally dilated bower had significant ly more bowel edema at birth (p = 0.038), longer operative time (p = 0 .013), and higher overall rate of postoperative complications (p = 0.0 37). CONCLUSIONS: (1) Elective cesarean delivery does not improve neon atal outcome in infants with gastroschisis. (2) Abnormal ultrasonograp hic appearance of fetal bowel is associated with a more difficult repa ir and a higher overall incidence of postoperative complications