Is vaginal delivery preferable to elective cesarean delivery in fetuses with a known ventral wall defect?

OBJECTIVE: We sought to test the hypothesis that vaginal delivery compared with elective cesarean delivery results in improved neonatal outcome in fet uses with a known isolated ventral wall defect. STUDY DESIGN: We performed a retrospective chart review. RESULTS: Between 1989 and 1999, we identified 102 infants with a confirmed antenatal diagnosis of an isolated ventral wall defect with either the diag nosis of an omphalocele or gastroschisis. Sixty-six infants were delivered by cesarean and 36 were delivered vaginally. There were no significant demo graphic differences between the study groups or between the two sites excep t that one center (Cincinnati) usually delivered these fetuses by cesarean whereas the other (Louisville) usually delivered such fetuses vaginally. Ov erall, there were a greater number of infants with gastroschisis than ompha locele (gastroschisis, n = 71; omphalocele, n = 31). After we controlled fo r primary versus staged closure of ventral wall defect and gestational age at delivery; the medians and interquartile ranges for cesarean and vaginal delivery were 39 (25, 63) days versus 42 (26, 75) days, respectively (P = . 32), for neonatal length of stay and 13 (9, 18) days versus 13 (9, 26) days , respectively (P = .16), for days to enteral feeding. After we controlled for the size of the defect and the amount of bowel resected, the odds of pr imary closure given a vaginal delivery was about half that given a cesarean delivery (odds ratio, 0.56; 950ib confidence interval, 0.18-1.69), but thi s was not statistically significant. There was no statistically significant difference in the rates of neonatal death (2 [3%] vs 2 [6%]; P = .61) and neonatal sepsis (2 [3%] vs 4 [11%]; P = .18) for cesarean versus vaginal de livery. Maternal length of stay after delivery was found to be 1 day less a fter vaginal delivery [vaginal, 2 (2, 2) days; cesarean, 3 (2, 3) days; P = .0001]. There were 5 instances of maternal complications, and all 5 pregna ncies were delivered by cesarean (P = .16). CONCLUSION: Fetuses with an antenatal diagnosis of an isolated ventral wall defect may safely be delivered vaginally, and cesarean delivery should be performed for obstetric indications only.