OP33.10: In fetal gastroschisis, perinatal outcome is better following induction of labour at 37 weeks than with expectant management

To evaluate obstetric and neonatal outcomes after induction of labor at 37 wks versus expectant management in pregnancies complicated by fetal gastroschisis. 261 pregnancies with fetal gastroschisis were reviewed (1980–2011). Ultrasound surveillance and non-stress tests were performed every 2 weeks from 30 wks, weekly from 34 wks and twice weekly after 35 wks. Delivery was undertaken if testing was abnormal. For those not urgently or spontaneously delivered, labor has been induced at 37 wks since 1994. Among the 261 cases, 53 (20.3%) delivered < 37 wks (32 spontaneous labor, 21 urgent deliveries for maternal-fetal indications), 27 (10%) had an elective caesarean sections (CS) > 37 wks and 28 (11%) were induced for other reasons at 38–41 wks. Of 153 remaining cases, 77 (30%) were routinely induced at 37 wks and were compared to 76 (29%) patients allowed to labour spontaneously. There were no significant differences in maternal age (22 years in both groups), parity (56% vs. 66% primipara), presence of other fetal anomalies (12% vs. 9%), caesarean section rate (20% in both groups), 5 minute Apgar < 7 (10% vs. 12%), meconium at birth (36% vs. 49%), respiratory distress syndrome (16% vs. 7%) between the induced and expectantly managed groups. However, neonatal sepsis (25% vs. 42%, P = 0.02) and a composite outcome of neonatal death and bowel damage (necrosis, atresia, perforation, adhesion − 8% vs. 21%, P = 0.02) were more common in expectantly managed cases. Moreover, time to oral feeds (−3.4 days), time on TPN (−6.2 days) and hospital stay (−6.7 days) were reduced when labor was induced. In fetuses with gastroschisis, induction of labour at 37 weeks was associated with reduced risks of sepsis, bowel damage and neonatal death compared to those managed expectantly beyond 37 weeks. Improved neonatal outcomes were not at the expense of worse obstetric outcomes, since Caesarean section rates were similar between induced and expectantly managed cases.