Trends in Attempted Vaginal Delivery among Pregnancies Complicated by Gastroschisis, 2014 to 2020

Christina N. Schmidt; Timothy Wen; Alexander M. Friedman; Mary E. D'Alton; Maria Andrikopoulou

doi:10.1055/a-1990-8668

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(05): 543-547
DOI: 10.1055/a-1990-8668

Short Communication

Trends in Attempted Vaginal Delivery among Pregnancies Complicated by Gastroschisis, 2014 to 2020

Christina N. Schmidt

¹School of Medicine, University of California, San Francisco, California

,

Timothy Wen

²Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California

,

Alexander M. Friedman

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

,

Mary E. D'Alton

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

,

Maria Andrikopoulou

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

› Institutsangaben

Abstract

Objective Gastroschisis is a full-thickness congenital defect of the abdominal wall through which intestines and other organs may herniate. In a prior analysis, attempted vaginal delivery with fetal gastroschisis appeared to increase through 2013, although cesarean delivery remained common. The objective of this analysis was to update current trends in attempted vaginal birth among pregnancies complicated by gastroschisis.

Study Design We performed an updated cross-sectional analysis of live births from 2014 and 2020 using data from the U.S. National Vital Statistics System and evaluated trends in attempted vaginal deliveries among births with gastroschisis. Trends were evaluated using joinpoint regression. We constructed logistic regression models to evaluate the association between demographic and clinical variables and attempted vaginal delivery in the setting of gastroschisis.

Results Among 5,355 deliveries with gastroschisis meeting inclusion criteria, attempted vaginal delivery increased significantly from 68.9% to 75.1%, an average annual percent change of 1.7% (95% confidence interval [CI], 0.8–2.5). Among gastroschisis-complicated pregnancies, patients 35 to 39 years old (adjusted odds ratio [aOR], 0.53; 95% CI, 0.37–0.79) and Hispanic race/ethnicity (aOR, 0.69; 95% CI, 0.58–0.62) were at lower likelihood of attempted vaginal delivery in adjusted analyses.

Conclusion These findings suggest that vaginal delivery continues to increase in the setting of gastroschisis. Further reduction of surgical delivery for this fetal defect may be possible.

Key Points

Vaginal deliveries increased among gastroschisis pregnancies.
Hispanic patients were less likely to attempt vaginal delivery.
Some gastroschisis pregnancies still deliver surgically.

Keywords

gastroschisis - vaginal delivery - cesarean section - joinpoint regression

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Referenzen

References
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