Obstetric and Delivery Characteristics Associated with Gastroschisis [14C

Abstract

INTRODUCTION: Gastroschisis is a congenital abdominal wall defect associated with complications such as cesarean delivery (CD). Previous studies have reported greater than 30% of these pregnancies having fetal intolerance of labor (FIOL). We sought to characterize obstetric factors associated with gastroschisis. METHODS: Population-based retrospective cohort study of livebirths in Ohio (2006-2015). Frequency of gastroschisis was obtained from birth certificate data. Obstetric characteristics were compared between women who delivered an infant with gastroschisis compared to those who without gastroschisis. Multivariate logistic regression estimated the influence of gastroschisis on the outcomes of FIOL and CD. RESULTS: Of 1,428,125 live births in Ohio during the 10-year study period, 620 (0.04%) women delivered an infant with a isolated gastroschisis. The CD rate was 45.7% vs 31.0% (p<0.001) in women who delivered an infant with gastroschisis compared to those without gastroschisis. Among women who were induced, the rate of FIOL was 13.4% vs 10.3% (p=0.145) in gastroschisis compared to non-gastroschisis pregnancies respectively. After adjusted analysis, women with gastroschisis pregnancies were not more likely to have FIOL (aOR 0.9, 95% CI 0.6-1.2) compared to those without gastroschisis. Among women who underwent CD, 79.4% (n=181/228) had a primary CD without a trial of labor despite being vertex. CONCLUSION: We did not find an association of intrapartum FIOL in gastroschisis pregnancies. Less than 15% of pregnancies with gastroschisis are complicated by FIOL despite having a higher rate and association with CD. Elective CD should be avoided in pregnancies with gastroschisis given the known maternal morbidity and lack of neonatal benefit.