Omphalocele delivery enigma: the best mode of delivery still remains dubious

Objective:To determine an optimal route of delivery for fetuses with prenat ally diagnosed omphalocele. Data source: MEDLINE(C)search of years 1966-199 6. Results: Descriptive retrospective analyses do not support the idea that cesarean delivery of fetuses with omphalocele is associated with an improv ed survival rate. However, most of those studies do not control for confoun ding variables like type and severity of associated anomalies, omphalocele size, prematurity rate, presence of trial of vaginal delivery, rate of intr apartum sac rupture, tertiary treatment centers accessibility, time and typ e of surgical correction, and postoperative morbidity. There is no evidence that vaginal delivery is safer than cesarean for fetuses with isolated sma ll omphalocele. Fetuses with giant (>5 cm) omphalocele should be delivered by cesarean section. Vaginal delivery at term is offered for fetuses with c oexisting life-threatening anomalies. Conclusions: We propose that until ra ndomized trial of vaginal and cesarean delivery for fetal omphalocele is av ailable, the preferred mode of delivery would be the vaginal route as that is safer for the mother. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.