Indication for delivery and neonatal outcomes in prenatally diagnosed gastroschisis: A 20-year retrospective cohort study.

Abstract

Background: The optimal timing and indication for delivery in gastroschisis remain subjects of ongoing debate. This study evaluates clinical characteristics and postnatal outcomes associated with varying indications for delivery in this population.

Methods: This Institutional Review Board approved retrospective cohort study included all pregnancies with a prenatal ultrasound diagnosis of gastroschisis delivered between 34 0⁄7 and 38 6⁄7 weeks' gestation at a single tertiary care center from January 2000 through December 2023. This gestational age range represents a clinically relevant window encompassing late-preterm and early-term births, during which delivery timing is frequently influenced by physician decision-making rather than spontaneous labor. Pregnancies were categorized according to indication for delivery into three groups: (1) medically indicated delivery, defined as delivery prompted by maternal, fetal, or placental conditions, including abnormal fetal surveillance findings (non-stress test or biophysical profile); (2) spontaneous labor, defined as spontaneous onset of labor without preceding fetal surveillance abnormalities or ultrasound-based concerns; and (3) fetal bowel concern, defined as delivery prompted by ultrasound findings suggestive of bowel compromise, including persistent bowel dilation, bowel wall thickening, or increased echogenicity. Neonatal outcomes assessed included age at abdominal wall closure, number of surgical interventions within the first month and first year of life, length of hospital stay, incidence of sepsis, age at initiation of enteral feeding, and rate of complex gastroschisis. Comparisons of outcomes across delivery indication groups were adjusted for gestational age at delivery.

Results: A total of 83 infants met the inclusion criteria, including 22 delivered for fetal bowel concern, 36 for medically indicated delivery, and 25 following spontaneous labor. Age at abdominal wall closure occurred significantly earlier in the medically indicated delivery and spontaneous labor groups compared with the fetal bowel concern group after adjustment for gestational age at delivery (adjusted p = 0.013 and p = 0.025, respectively). There were no significant differences across delivery indication groups in the number of surgical interventions within the first month or first year of life, length of hospital stay, incidence of sepsis, age at initiation of enteral feeding, or rate of complex gastroschisis.

Conclusion: Although bowel-related concerns frequently prompted delivery, this approach was not associated with improvements in key neonatal outcomes in this cohort. In contrast, infants delivered following spontaneous labor or medically indicated delivery demonstrated comparable, and in some cases more favorable, postnatal trajectories. These findings question the clinical utility of bowel-related concerns, as documented in clinical practice, as a sole indication for delivery in gastroschisis and support reliance on established obstetric surveillance and guideline-consistent decision-making when determining delivery timing, within the context of the study's limitations.