Fetal growth standards in gastroschisis: Reference values for ultrasound measurements

Barbieri, Mariane Massaini; Bennini, João Renato; Nomura, Marcelo Luís; Morais, Sirlei Siani; Surita, Fernanda Garanhani

doi:10.1002/pd.5179

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…Results from this increased surveillance account for up to a third of expedited deliveries among gastroschisis‐affected pregnancies, of which nearly 90% are delivered by caesarean . A recent publication of foetal growth standards specific to gastroschisis provides an important reference for growth monitoring, and future studies will be able to examine how this translates to shifts in mode of delivery. Reframing guidelines for foetal heart rate monitoring management among these foetuses with an eye to interpretation of heart rate variability may present another opportunity for caesarean rate reduction.…”

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Gastroschisis and mode of delivery: It’s complex

Parker

Yarrington

2019

Paediatric Perinatal Epid

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Commentary on: Lopez A, Benjamin RH, Raut JR, Ramakrishnan A, Mitchell LE, Tsao K, et al. Mode of delivery and mortality among neonates with gastroschisis: A population-based cohort. in Texas. Gastroschisis is an increasingly prevalent abdominal wall defect affecting approximately 5 per 10 000 births. 1 Controversy in the late 1980s regarding the safest mode of delivery for foetuses with a prenatal diagnosis of gastroschisis has since been replaced with a general consensus in the obstetric community that vaginal delivery can be attempted, barring other obstetric complications. The basis for this consensus comes from numerous studies showing no benefit of caesarean delivery on neonatal outcomes. 2 Despite this evidence base, rates of caesarean delivery for gastroschisis in the United States remain as high as 60%, leaving room for improvement. 3In this issue of Paediatric and Perinatal Epidemiology, Lopez et al 4 revisit this topic, specifically focusing on infant mortality as the outcome, using a large birth defect registry-based cohort of infants with gastroschisis. This study has many strengths including the use of a large, population-based sample that identified cases through medical record review, which has been shown to be a superior method of case ascertainment than birth certificates. 5 Data on potential confounders were also collected and included in adjusted models which represents an improvement over many of the previously published studies on this topic. The results from their analysis, in addition to their update of a meta-analysis, demonstrate no association between mode of delivery and mortality among infants with gastroschisis. While these data are important in contributing to the evidence that supports attempted vaginal delivery, they offer no actionable approaches to reducing the rate of caesarean delivery among these pregnancies. After numerous studies of mode of delivery and mortality, it is now time to understand what drives mode of delivery decision making among pregnancies affected by gastroschisis to identify opportunities to reduce the rate of caesarean among this very specific population. Indications for caesarean delivery in gastroschisis-complicatedpregnancies should be the same as in uncomplicated pregnancies. 6 Some indications for caesarean delivery, such as foetal heart rate abnormalities, are more common in foetuses with gastroschisis, and therefore, a higher rate of caesarean as a direct result of such obstetric complications among these pregnancies is expected. It follows, then, that in order to reduce the caesarean rate, other factors that influence obstetric decision making need to be elucidated. While there is evidence that attempted vaginal delivery among otherwise uncomplicated pregnancies affected by gastroschisis is increasing, planned caesareans still account for a third of these deliveries, 7 representing a group that may be targeted for caesarean rate reduction.Guidance around results of antepartum surveillance among foetuses with gastroschisis as it relates to mode of d...

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