Optimal Mode Of Delivery Research Articles

The optimal mode of delivery for the haemophilia carrier expecting an affected infant is vaginal delivery

The optimal mode of delivery of a haemophilia carrier expecting a child is still a matter of uncertainty and debate. The aim of this commentary/review is to suggest that normal vaginal delivery should be the recommended mode of delivery for the majority of carriers, based on review of studies on obstetric aspects of haemophilia. About 2.0-4.0% of all haemophilia boys born in countries with a good standard of health care will suffer from ICH during the neonatal period. This is an average figure including all modes of delivery and regardless of whether the carrier status of the mother or the haemophilia status of the foetus was known or not at the time of delivery. On the basis of current literature, one may conclude that the risk of serious bleeding in the neonate affected with haemophilia is small in conjunction with normal vaginal delivery. It should be possible to further reduce the low frequency of complications if appropriate precautions are taken when planning the delivery in pregnant woman with known carrier status, if the sex of the foetus is known and, even more, when the haemophilia status of the foetus is known. Instrumental delivery such as use of vacuum extraction and foetal scalp monitors must be avoided at delivery of carriers.

The optimal mode of delivery for the haemophilia carrier expecting an affected infant is caesarean delivery

While a majority of affected infants of haemophilia carriers who deliver vaginally do not suffer a head bleed, the outcome of labour cannot be predicted. A planned vaginal delivery puts a woman at risk of an abnormal labour and operative vaginal delivery, both of which predispose to intracranial haemorrhage. Furthermore, vaginal delivery does not eliminate the risk to the haemophilia carrier herself. Overall, maternal morbidity and mortality from planned vaginal delivery are not significantly different from those from planned caesarean delivery. Caesarean delivery is recommended or elected now in conditions other than haemophilia carriage, where the potential benefits are not nearly as great. Additionally, vaginal delivery of the haemophilia carrier poses medical/legal risks if the infant is born with cephalohaematoma or intracranial haemorrhage. Caesarean delivery allows for a planned, controlled delivery. Caesarean delivery reduces the risk of intracranial haemorrhage by an estimated 85% and the risk can be nearly eliminated by performing elective caesarean delivery before labour. Therefore, after a discussion of the maternal and foetal risks with planned vaginal delivery versus planned caesarean delivery, haemophilia carriers should be offered the option of an elective caesarean delivery.

Prise en charge de l’accouchement du deuxième jumeau

To determine the optimal mode of delivery of the second twin according to his presentation. The PubMed data base has been consulted. Considering longer intertwin intervals are correlated with poorer umbilical artery blood gas results and are associated with greater rates of cesareans for the second twin after vaginal birth of the first twin and increased neonatal morbidity of the second twin, second twin delivery should be actively managed for reducing this interval (EL3). In case of non cephalic presentation of the second twin, immediate total breech extraction, after internal version in case of transverse lie, could be associated with lower rates of cesareans for the second twin (EL3). In these situations, external version might be deleterious (EL3). In case of cephalic presentation above a 0 station, and if the obstetrical team is trained in obstetrical maneuvers, internal version followed by immediate total breech extraction could be preferred to the association of maternal pushing efforts, oxytocin infusion and artificial rupture of the membranes, because this first strategy might be associated with less cesareans for the second twin (EL4). In case of cephalic presentation at or below a 0 station, management of second twin delivery should consist in the association of maternal pushing efforts, oxytocin infusion and artificial rupture of the membranes (EL3). All the obstetrical maneuvers for second twin delivery should be performed in first intent with intact membranes (EL5). Second twin delivery should be actively managed and largely depends on the knowledge of specific obstetrical maneuvers. Training residents to these maneuvers remains a priority.

Reply

We thank Dr Lau et al. for their Letter to the Editor commenting on our Editorial/Opinion1, which was published recently in Ultrasound in Obstetrics and Gynecology, as well as the work of Henrich et al.2, Ghi et al.3, Barbera et al.4, 5 and Kalache et al.6. Lau et al. share with us their experience with 20 patients who underwent transperineal ultrasound after a prolonged second stage of labor, and who were managed at the discretion of the treating physician. A novel aspect of the work of Lau et al. is that they compare the angle of progression obtained between contractions (referred to as ‘at rest’) and that obtained during a contraction and bearing-down efforts (‘during pushing’). They contribute to the field by adding a new parameter which has promise and deserves further study. We agree that large prospective studies are required to assess the value of transperineal ultrasound and the different parameters which have been proposed for predicting the optimal mode of delivery and the outcome of labor (angle of progression at rest4, 5 and during pushing, as suggested by Lau et al., head direction2, head progression distance7 and degree of rotation of the fetal head3). It would be ideal if obstetricians managing the second stage of labor could be blinded to the ultrasound results for the purposes of research. Ultrasound holds promise to optimize the management of the second stage of labor, and we encourage studies in this field. This can be done with a simple ultrasound machine, because the angle of progression4, 5, the direction of the fetal head2 and the head progression distance7 can be assessed using conventional two-dimensional ultrasound. It remains to be determined whether the use of three-dimensional ultrasound may add value to these studies3. The availability of new hardware and software systems makes systematic comparison of these parameters easier. We look forward to future contributions by Lau et al., as well as other investigators, to this emerging field of research in ultrasound. L. Yeo*, R. Romero*, * Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Development, NIH, DHHS, Bethesda, MD and Detroit, MI and Wayne State University, Detroit, MI, USA

Successful expectant management for a cornual heterotopic pregnancy

To report the obstetric outcome after expectant management for a right cornual heterotopic pregnancy. Case report. University hospital. A 33-year-old salpingectomized woman with an 8-year history of primary infertility who conceived after in utero transfer of two embryos obtained by in vitro fertilization. Expectant management and close ultrasonographic and clinical monitoring. Obstetric outcome. The intrauterine pregnancy proceeded unremarkably. A caesarean section was performed for dystocia and allowed the delivery of a healthy 4170 g male infant. The examination of the uterus showed a prerupture of the right uterine horn. Expectant management for cornual heterotopic pregnancy could be considered a successful option in a symptom-free patient where the ectopic embryo has a limited craniocaudal length with no cardiac activity. Our case also suggests that elective cesarean section could be the optimal mode of delivery for rare cases of successful management for cornual heterotopic pregnancy, regardless of the therapeutic option chosen for the cornual pregnancy, due to the theoretical increase risk of uterine rupture during labor.

High-dose therapy with hematopoietic stem cell rescue in patients with poor prognosis Ewing family tumors

The purpose of the study was to evaluate the feasibility and safety of two cycles of high-dose chemotherapy (HDT) followed by autologous hematopoietic SCT (HSCT) in patients with poor prognosis Ewing family of tumors (EFT). Twenty patients with primary metastatic bulky disease or recurrent EFT were enrolled to a treatment protocol with two cycles of HDT and HSCT. Patients tolerated well the first (n=20) and second (n=13) cycles, with limited and predictable toxicities. Only one (5%) TRM occurred during the second cycle. Myeloid engraftment occurred at the median of 11 days after both cycles. At 3 years, the overall and EFS were 45% (confidence interval; CI 0.22, 0.69) and 47% (CI 0.25, 0.70), respectively, for the entire group and 58% (CI 0.30, 0.86) for patients who completed two cycles. Dose intensification with two cycles of HDT and HSCT is feasible and safe, with low and acceptable treatment-related morbidity and mortality. Adding a second course of therapy does not impair engraftment. However, only 65% of the patients were able to proceed to the second cycle. Further studies are required to define the optimal mode of delivery of HDT and HSCT in treatment of advanced EFT.

Modulation of miRNA activity in human cancer: a new paradigm for cancer gene therapy?

MicroRNAs (miRNAs) were discovered more than a decade ago as noncoding, single-stranded small RNAs (approximately 22 nucleotides) that control the timed gene expression pattern in Caenorhabditis elegans life cycle. A number of these evolutionarily conserved, endogenous miRNAs have been shown to regulate mammalian cell growth, differentiation and apoptosis. miRNAs are multispecific by nature. The individual miRNA is capable of modulating the expression of a network of mRNAs that it binds by imperfect sequence complementarity. Human cancers commonly exhibit an altered expression profile of miRNAs with oncogenic (miR-21, miR-106a and miR-155) or tumor-suppressive (let-7, miR-15a/16, miR-34a and miR-143/145) activity. As consistent with the natural function of miRNAs in specifying cellular phenotype, miRNA-based cancer gene therapy offers the theoretical appeal of targeting multiple gene networks that are controlled by a single, aberrantly expressed miRNA. Reconstitution of tumor-suppressive miRNA, or sequence-specific knockdown of oncogenic miRNAs by 'antagomirs,' has produced favorable antitumor outcomes in experimental models. We discuss pending issues that need to be resolved prior to the consideration of miRNA-based experimental cancer gene therapy. These include the need for definitive mRNA target validation, our incomplete understanding of rate-limiting cellular components that impact the efficiency of this posttranscriptional gene-silencing phenomenon, the possibility for nonspecific immune activation and the lack of a defined, optimal mode of delivery.

Management of cornual (interstitial) pregnancy

Key content The Confidential Enquiry into Maternal and Child Health report for 2000–02 stated that cornual pregnancy is a rare but dangerous type of ectopic pregnancy. Four out of the 11 deaths from ruptured ectopic pregnancy were due to ruptured cornual pregnancy. In all four cases the diagnosis was made only after rupture. Haemorrhage can be severe because pregnancy is often more developed than extrauterine tubal pregnancy and because of the large blood supply to the uterus. Clinicians should be aware of the difficulties with both clinical and ultrasound diagnosis. Many case reports have been written about sporadic cases of intact and ruptured cornual pregnancy and several treatment modalities discussed. There are very few publications collecting all management strategies, including both surgical and medical treatment, for this dangerous type of ectopic pregnancy. Learning objectives To understand recent advances in diagnosis and conservative laparoscopic and medical treatment. To review the most reputable case reports discussing all modalities of treatment, including radical surgical and conservative laparoscopic methods and different types of medical treatment, with critical appraisal of each approach. Ethical issues How should a couple be counselled regarding future pregnancy risks and the optimum mode of delivery? Please cite this article as: Faraj R, Steel M. Management of cornual (interstitial) pregnancy. The Obstetrician & Gynaecologist 2007;9:249–255.

Surgical treatment of inflammatory bowel diseases and pregnancy

Ulcerative colitis (UC) and Crohn's disease (CD) affect women of reproductive age. Surgical intervention is often required. Therefore, the implications of disease treatment and pregnancy need to be understood. The standard surgery for UC is proctocolectomy, followed by ileal pouch anal anastomosis (IPAA). This review summarises the literature describing the effects of IPAA on gynaecologic and sexual health, fertility, pregnancy, labour and delivery. The emerging role of laparoscopic IPAA and the limited role of ileo-rectal anastomosis (IRA) are discussed. The experience with emergency surgery in pregnant women with ulcerative colitis is also presented. The literature explores two key issues of pregnancy in CD: the possible effect of pregnancy decreasing resection rates, and the optimal mode of delivery, especially in the setting of perianal CD. These two issues together with the available literature describing stoma function during pregnancy and the foetal outcome after surgical therapy are presented.

Therapeutic Efficacy of Cold Therapy After Intraoral Surgical Procedures: A Literature Review

Cryotherapy (e.g., ice pack) is prescribed commonly after oral surgery to inhibit swelling and discomfort. However, there is a dearth of data concerning various aspects of cold therapy: optimal delivery mode, best interval for application (time on/time off), and total duration of treatment to attain desired clinical outcomes. The literature was searched for clinical trials that assessed the benefits of cryotherapy after oral surgical procedures. In addition, other studies were reviewed that evaluated physiological responses to cold therapy. To inhibit signs of inflammation and achieve beneficial results with cryotherapy, skin temperature (normally 33 degrees C) needs to be reduced to 10 degrees C to 15 degrees C. Cold therapy usually decreased skin temperature to 10 degrees C to 15 degrees C within 10 to 20 minutes. Physiological studies indicated cryotherapy resulted in vasoconstriction, reduction of edema, and diminished pain perception. Various methods can be used to lower tissue temperature. Ice or gel packs are easy and efficient techniques to cool tissues. Seven studies published in English were found that addressed the use of cryotherapy after oral surgical procedures. Five investigations demonstrated no clinical benefits from cold therapy, and two studies indicated that cryotherapy reduced post-surgical edema and pain. The time interval for cold applications varied in different studies (10 minutes to continuous for hours). There seemed to be consensus among clinicians that cryotherapy should be applied for 10 to 20 minutes followed by a rest period. The duration of therapy ranged from 2 to 72 hours. No clinical trials were conducted to determine the optimal interval of cold application (time on/off) or extended duration of cryotherapy after surgical procedures to attain the best therapeutic benefits. Ice applied after surgical procedures may reduce swelling and discomfort. However, data from studies regarding the benefits of ice therapy after oral surgery are inconclusive. To resolve this ambiguity, additional clinical trials need to be conducted.

Neutron dose in proton radiation therapy: In regard to Eric J. Hall (Int J Radiat Oncol Biol Phys 2006;65:1–7)

Dr. Hall ( 1 Hall E.J. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006; 65: 1-7 Abstract Full Text Full Text PDF PubMed Scopus (869) Google Scholar ) comes to the conclusion that proton therapy offers an advantage with respect to scattered doses relative to photons only if pencil beam scanning (PBS) is applied but not for broad-beam modulated (BBM) beams. We disagree with this conclusion. 1Neutron dose depends on beam delivery parameters. Intensity-modulated radiation therapy, protons, and the risk of second cancersInternational Journal of Radiation Oncology, Biology, PhysicsVol. 65Issue 1PreviewIntensity-modulated radiation therapy (IMRT) allows dose to be concentrated in the tumor volume while sparing normal tissues. However, the downside to IMRT is the potential to increase the number of radiation-induced second cancers. The reasons for this potential are more monitor units and, therefore, a larger total-body dose because of leakage radiation and, because IMRT involves more fields, a bigger volume of normal tissue is exposed to lower radiation doses. Intensity-modulated radiation therapy may double the incidence of solid cancers in long-term survivors. Full-Text PDF Neutron dose in scattered and scanned proton beams: In regard to Eric J. Hall (Int J Radiat Oncol Biol Phys 2006;65:1–7)International Journal of Radiation Oncology, Biology, PhysicsVol. 66Issue 5PreviewDr. Hall’s Fig. 10 (1) is incorrect by a factor ≥9 to the detriment of scattered vs. scanned protons. We wish to clarify the source of neutrons in scattering systems, to correct his Fig. 10, and to put neutron doses into perspective. Full-Text PDF In reply to Drs. Macklis Gottschalk, Paganetti, et alInternational Journal of Radiation Oncology, Biology, PhysicsVol. 66Issue 5PreviewWe are indebted to Drs. Gottschalk, Paganetti, and colleagues for their elegant clarifications of the sources of whole-body neutron exposures in modern proton therapy facilities: their collective knowledge and experience in this field are unmatched. We should, at the outset, say that our comments relate to the optimal mode of delivery of radiotherapeutic proton beams—not to the potential advantages of protons versus photons. Full-Text PDF In regards to Hall: Intensity-modulated radiation therapy, protons, and the risk of second cancers (Int J Radiat Oncol Biol Phys 2006;65:1–7)International Journal of Radiation Oncology, Biology, PhysicsVol. 66Issue 5PreviewSeveral recent articles in the medical literature have discussed the risk of secondary cancers occurring within the treatment field, as well as at nearby or distant sites that have received appreciable doses from scattered or leakage radiation (1–5). Many new high-tech beam-shaping approaches such as intensity-modulated radiation therapy/image-guided radiation therapy produce more conformal dose deposition patterns, but also may result in large volumes of nontarget tissue receiving low but non-negligible doses of unintentional scatter and exit radiation outside the treatment field. Full-Text PDF

Diagnosis and management of obstetric anal sphincter injury

The purpose of this review is to outline optimum practice in diagnosis and management of obstetric anal sphincter injury. The review focuses briefly on prevention of the problem before outlining diagnosis of sphincter injury as well as immediate and long-term management of patients who have sustained such injuries. Increasing vigilance is vital in order that sphincter injury is not overlooked; immediate radiological assessment may play a role in diagnosis. Optimum anal sphincter repair should be followed by oral laxative administration to maintain sphincter integrity. Biofeedback physiotherapy and sacral nerve stimulation show great promise in treatment of persistent symptoms. Optimum mode of delivery in future pregnancies is not clearly defined, and decisions should be individualized. Because obstetric injury to the anal sphincter mechanism cannot always be prevented, efforts must focus on limiting its occurrence, documenting its severity and providing optimum therapy to women who have sustained it. Management includes routine postnatal review of at-risk women and antenatal assessment in future pregnancies to limit deterioration in continence after future deliveries.

Analysis of 140 Cases of Asphyxia of Newborn in Caesarean Sections

目的 探讨新生儿窒息发生的相关因素,提出干预措施.方法对2003年1月～2005年1月在南海金沙医院出生的新生儿窒息140人的相关因素进行回顾性分析.结果新生儿窒息为综合因素所致,多为胎儿窘迫的延续.胎儿高危因素为93.57%,分娩时高危因素高达92.86%,母体高危因素为67.86%.结论加强围产期保健,及时处理高危妊娠,综合分析可能发生新生儿窒息的高危因素,适时正确选择分娩方式是降低新生儿窒息和病死率的关键措施。

Zinc in skin pathology and care

Objectives: To assess the significance of zinc in the etiology of various dermatological conditions and examine the role of zinc as a mode of treatment for a wide range of dermatoses. Methods: Review of existing literature through searches using the PubMed site with zinc and the dermatosis in question as search words. Results: Severe zinc deficiency states such as acrodermatitis enteropathica are associated with a variety of skin manifestations, such as perioral, acral and perineal dermatitis. These syndromes can be reversed with systemic zinc repletion. In addition to skin pathologies which are clearly zinc‐dependent, many dermatological conditions (e.g. dandruff, acne and diaper rash) have been associated and treated with zinc. Success rates for treatment with zinc vary depending on the disease, mode of application and zinc salt used. Usually, alternative modes of treatment are superior to zinc. Conclusions: Generally, it seems that with the exception of systemic deficiency states, there is very little evidence to convincingly demonstrate the efficacy of zinc as a first‐line treatment for any dermatological conditions. Further research is needed in order to establish the indications for zinc treatment in dermatology, optimal mode of delivery, type of compound and therapeutic indexes.

Elective cesarean delivery: when is it justified?

There has been much recent debate regarding the optimal mode of delivery. In a clinical commentary in the New England Journal of Medicine, the risks and benefits of elective primary cesarean delivery to both the mother and neonate were discussed.1 While a small number of neonates may benefit from elective cesarean delivery, the woman undergoing cesarean incurs increased surgical risk. In addition, there are increased risks to both the mother and neonate in subsequent pregnancies. Trials of labor after cesarean and elective repeat cesareans both carry increased risks.2, 3 Further, the risk of intrauterine fetal demise may be higher in women with a prior cesarean delivery.4

Impact of Cancer Treatment on Uterine Function

Fertility and future pregnancy potential are of concern to survivors of childhood cancer. Radiotherapy causes both ovarian and uterine damage. There are no reports of uterine damage after chemotherapy. The magnitude of risk is related to age at treatment, dose, and schedule. The dose of radiation required to destroy fifty percent of immature oocytes is <2 Gy. Reduced ovarian volume and low inhibin B and anti-Mullerian hormone concentrations in survivors with regular menses may be markers of incipient ovarian failure. Uterine damage, manifest by impaired growth and blood flow, is a likely consequence of pelvic irradiation. Uterine volume correlates with age at irradiation. Exposure of the pelvis to radiation is associated with an increased risk of miscarriage, midtrimester pregnancy loss, preterm birth, and low birthweight. The optimal dose and delivery route of estrogen replacement required to facilitate uterine growth in adolescent women treated with total body irradiation in childhood needs to be established. If female survivors of childhood cancer do achieve a pregnancy, then these pregnancies are high risk, pose a challenge for optimal mode of delivery, and require a multidisciplinary approach to management.

Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture

Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture

Forceps vs. vacuum: Which is associated with the greatest morbidity?

AARON B. CAUGHEY, PER SANDBERG, MARYA ZLATNIK, JULIAN T. PARER, MARIPAULE THIET, RUSSELL K. LAROS JR, University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California, California Pacific Medical Center, Obstetrics and Gynecology, San Francisco, California OBJECTIVE: To compare perinatal outcomes between forceps and vacuum assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocia, but greater perineal lacerations. STUDY DESIGN: This is a retrospective cohort study of 4120 term, cephalic, singleton, operative vaginal deliveries at a single institution. Outcomes examined included rates of shoulder dystocia, perineal and cervical lacerations, and neonatal trauma. Potential confounders including maternal age, birthweight, ethnicity, parity, gestational age, station at delivery, episiotomy, attending physician, anesthesia, and lengths of 1st and 2nd stages of labor were controlled for using multivariate logistic regression. RESULTS: In the study population, there were 2045 (49.6%) forceps and 2075 (50.4%) vacuum assisted deliveries. Of note, the rate of shoulder dystocia was higher among women undergoing vacuum assisted delivery (3.5% vs. 1.5%, P! .001). Other differences are reported in the table below. These differences in perinatal complication rate persisted when controlling for the confounders listed above with adjusted odds ratio for shoulder dystocia being 3.05 (95% CI 1.85– 5.04), and 3rd or 4th degree lacerations being 0.65 (95% CI 0.55–0.75) when comparing vacuum to forceps. CONCLUSION: Vacuum assisted vaginal birth is more often associated with shoulder dystocia and cephalohematoma. Forceps delivery is more often associated with 3rd and 4th degree perineal lacerations as well as cervical lacerations. These differences in complications rates should be considered among other factors when determining the optimal mode of delivery.

Cardiac Disease in Pregnancy

After completing this article, readers should be able to: 1. Describe how the cardiovascular changes of pregnancy can affect the woman who has cardiac disease. 2. Review the importance of preconception counseling. 3. Discuss the purpose of a multidisciplinary team approach to the management of the woman who has cardiac disease during pregnancy. 4. Review delivery management of women who have cardiac disease. Pregnancy causes considerable physiologic change in women, particularly in their cardiovascular systems. Circulating blood volume increases dramatically, and cardiac output increases up to 50% by the end of pregnancy. Pregnant women who have cardiac disease must be able to accommodate these normal changes to have a successful pregnancy. Inability to do so can result in increased morbidity and mortality. Cardiac disease is an important cause of nonobstetric mortality during pregnancy and can result in significant morbidity. (1)(2) Approximately 10% of all maternal deaths in the United States can be attributed to cardiac disease, a number that has remained consistent for the last half century. (1) In one study of 1,000 pregnant women who had various types of cardiac disease and were followed by the same health-care team over a 10-year period, more than 75% of the women had no complications during pregnancy. (2) Among the remaining 25%, the following complications were seen most often: The overall maternal mortality rate in this group was 2.7%, and the stillbirth and spontaneous abortion rate was 7.7%. Cardiac disease covers a wide range of conditions, including congenital heart disease, acquired disease such as rheumatic valvular disease, and coronary disease. It is estimated that 1% to 3% of women either have cardiac disease entering pregnancy or are diagnosed with cardiac disease while they are pregnant. …

Routine cesarean delivery does not improve the outcome of infants with gastroschisis

Background/Purpose The optimal mode of delivery for infants with gastroschisis is controversial. The authors compared the outcomes of infants with gastroschisis born vaginally (VD) or by cesarean section (CS). Methods A retrospective analysis of infants with gastroschisis born between 1990 and 2000 was performed. Assessment included patient demographics, respiratory distress, method of closure, number of surgeries, presence of atresia, feeding parameters, parenteral nutrition days (TPN), time to full feeding (FPO), mortality, and length of stay (LOS). Subgroup analyses were performed for those infants requiring cesarean section for fetal distress. Student’s t test/analysis of variance (ANOVA) or χ 2/Fisher’s Exact tests were used for statistical analysis. Logistic and linear regression analyses were also performed. Results One hundred thirteen patients were studied (82 VD and 31 CS). No statistical difference existed between the VD and CS groups for perinatal complications, method of closure, number of surgeries (1.6 each), TPN (40.6 v 46.0 days), FPO (40.4 v 47.1 days), mortality (9.7 v 6.5%) and LOS (53.4 v 61.7 days). CS was associated with increased stenosis (25.8 v 4.9%; P = .003), gastrointestinal dysfunction (25.8 v 11.0%; P = .049), and respiratory distress (16.1 v 3.7%; P = .035). Many of these differences did not persist when infants undergoing CS for fetal distress were excluded from the analysis. However, regression analysis identified CS as an independent risk factor for the development of respiratory distress at birth (odds ratio, 7.11; CI, 1.06 to 47.7), with a trend to increased gastrointestinal dysfunction (odds ratio, 4.35; CI, 0.77 to 24.61). Conclusions The routine use of CS for infants with gastroschisis is not supported by our results because equivalent outcomes were observed with both modes of delivery. CS may be a necessary intervention for fetal distress.