article = {CROGR-2019-1-103}
title = {Gastroschisis: Impact of Delivery Planning on Patient Outcomes}
journal = {Case Reports in Obstetrics Gynecology and Reproductive}
year = {2019}
issn = {2674-5070}
doi = {http://dx.doi.org/10.31487/j.CROGR.2019.01.03}
url = {https://www.sciencerepository.org/gastroschisis-mpact-of-delivery-planning_CROGR-2019-1-103 
author = { Amy Sullivan,Burjonrappa Sathyaprasad,}
keywords = {Gastroschisis, vaginal delivery, cesarean section, planned delivery}
abstract ={Introduction: Success rates of gastroschisis interventions on outcome have been increasingly examined.
Much of the work has focused on post-delivery management and timing of the final closure. Little data is
available regarding the impact of the timing of fetal delivery on outcomes. This study aims to examine the
relationships between overall outcomes of patients diagnosed with gastroschisis and timing of delivery
(planned versus non-planned) and mode of delivery (cesarean section versus vaginal delivery). The primary
outcome evaluated was the length of hospitalization.
Methods: This work was performed as a ten-year retrospective chart analysis including patients from 2005
to 2013. Inclusion in the study required a pre-operative diagnosis and a surgical intervention for
gastroschisis. We identified 29 patients of interest who were filtered based on availability of the specific
timing of each intervention. Chi-square test was used to determine statistical differences amongst categorical
variables and the student t-test was used to determine differences amongst continuousvariables.
Results: The major factors influencing the Length of hospitalization were return of bowel function (p =
0.0213) and tolerance of full oral feeds (p = 0.0116). Further early extubation was also correlated to a shorter
hospitalization (p = 0.0003). Analysis of mode of delivery, comparing vaginal delivery to Cesarean section,
showed that patients delivered by Cesarean section had a reduced length of hospitalization as compared to
those delivered vaginally (p = 0.0080). Mode of delivery did not significantly impact the other patient
outcomes, but we did find that time to oral feeds was increased in those patients undergoing unplanned
deliveries (p = 0.0176). No other outcomes were impacted by undergoing a planned versus unplanned
gastroschisis delivery.
Conclusion: Our data suggests that patients delivered without prior planning will have an extended time to
tolerance of oral feeds. In addition, we find that patients delivered by Cesarean section will have shorter
lengths of hospitalizations in the setting of poor antenatal care. Factors influencing length of stay after
gastroschisis, such as return of bowel function and time to tolerance of oral feeds may be related to mode
and timing of delivery. We recommend that future analysis of larger databases should focus on peri-partum
factors that may influence outcomes in gastroschisis. Further greater consideration should be given to the
impact of lack of antenatal services in many parts of the world and its implications on maternal fetal
wellbeing in congenital malformations such as gastroschisis.
}