title: Effect of delivery approach on outcomes in fetuses with gastroschisis.
abstract: OBJECTIVE
  There is considerable controversy regarding optimal mode and timing of delivery for fetuses with gastroschisis. Our objectives were to describe the variation in institutional approach regarding these factors, and to evaluate the effect of timing of delivery on outcomes in fetuses with gastroschesis.
  
  
  METHODS
  Members of the maternal-fetal medicine community across Canada were surveyed regarding their personal and institutional approach of delivery. Data from the Canadian Pediatric Surgery Network (CAPSnet) were analyzed.
  
  
  RESULTS
  The survey showed significant variability in delivery approach between institutions, although no center routinely performs cesarean section. Infants delivered vaginally (VD) were categorized into three groups: Group 1, VD <36 weeks (n=114); Group 2, VD 36-37 weeks (n=218); and Group 3, VD ≥38 weeks (n=75). Score of Neonatal Acute Physiology, complication rates, length of time on total parenteral nutrition (TPN), and length of hospital stay (LOS) were higher in Group 1; bowel matting was greater in Group 3. There were no differences between the groups regarding other complications.
  
  
  CONCLUSIONS
  Our data suggest that preterm delivery was associated with more complications, longer time on TPN, and longer LOS; delivery ≥38 weeks was associated with increased bowel matting. These outcomes should be considered when determining institutional protocol.
authors.affiliation: Department of Surgery, Children's Hospital of Eastern Ontario. University of Ottawa, Ottawa, Ontario, Canada. Electronic address: ANasr@cheo.on.ca.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nasr
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wayne
authors.forename: Juan
authors.initials: J
authors.lastname: Bass
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
mesh_terms: D002170:Canada / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D004750:Enteral Nutrition; D005260:Female; D020139:Gastroschisis / Q000175:diagnosis / Q000196:embryology / Q000453:epidemiology*; D005865:Gestational Age; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D007409:Intestinal Atresia / Q000453:epidemiology; D007751:Labor, Induced / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D015997:Neonatal Screening; D009774:Obstetrics; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D012955:Societies, Medical
keywords: CAPSNet; Gastroschisis; Mode of delivery; Timing of delivery