"Managing Patients with Gastroschisis Through Early Elective Caesarean Delivery"

Abstract

Objective: Early elective caesarean (EEC) for patients with gastroschisis is controversial. Our objective was to compare gastroschisis complications in full-term patients and EEC-managed patients.Methods: Ambispective study (2016-2021) of patients undergoing gastroschisis surgery in our centre. Data were collected on demographics, prenatal and perinatal factors, therapeutic approach, surgical technique, intraoperative and postoperative complications, and follow-up of all patients with prenatal or perinatal gastroschisis diagnoses. Results: 3 EEC and 4 full-term interventions were performed on patients with gastroschisis. In the fullterm group, mean birth weight was 2440 g [range 1800-2680] and APGAR score was 9 [range 8.5-9]. Peel was identified in all cases and intestinal content re-introduction was not possible due to excessive abdominal pressure, requiring silo use. Abdominal wall closure was completed at mean 11 days [range 8-15]. Respiratory support with mechanical ventilation was maintained for a mean 20 days [range 15-25]. Enteral feeding was started at mean 23 days [range 22-24], and parenteral nutrition was withdrawn in mean 55 days [range 45-72]. Mean hospital stay was 64 days [range 56-74]. In the EEC group, EEC was performed between weeks 34 and 36 (mean 34.75). Mean weight at birth was 2320 g [range 1700-2980] and APGAR score was 9.125 [range 9-9.5]. A single case of mild peel developed in an exteriorized intestinal loop. Primary defect closure was successful in all cases. Respiratory support with mechanical ventilation was maintained for mean [SD] 2 days [1-7]. Enteral feeding started at mean 2.75 days [range 2-4], and parenteral nutrition was withdrawn at mean 19 days [range 10-27]. Mean hospital stay was 26 days [range 14-34]. Overall survival in both groups was 100%.Conclusion: EEC to treat gastroschisis seems to reduce perinatal complications, allows an early start to enteral nutrition, reduces the need for parenteral nutrition, and reduces hospital stay.