Mode of Delivery in Patients With Fetal Central Nervous System Anomalies

INTRODUCTION: Balancing maternal risk with fetal prognosis in counseling regarding mode of delivery can be challenging. This study investigates mode of delivery for patients with pregnancies complicated by fetal anencephaly and myelomeningocele. METHODS: We conducted a retrospective cohort study using National Vital Statistics Live Birth Data between 2014 and 2018. Inclusion criteria were patients without a history of cesarean delivery carrying singleton, cephalic fetuses that were at least 23 weeks of gestation. We compared mode of delivery among patients with pregnancies complicated by each central nervous system (CNS) anomaly to those without the anomaly. Chi-square and multivariable logistic regression were performed for statistical analyses using STATA version 17. RESULTS: A total of 15,032,798 patients met the inclusion criteria; 0.011% had fetal myelomeningocele and 0.008% had fetal anencephaly. Among women with fetal myelomeningocele, 63.1% underwent cesarean delivery compared to 17.7% for those without myelomeningocele ( P <.01). In patients with fetal anencephaly, 22.0% underwent cesarean delivery compared to 17.7% for those without anencephaly ( P <.01). After adjusting for confounders, the odds of cesarean delivery among patients with pregnancies complicated by myelomeningocele and anencephaly were 8.6 (95% CI, 7.7–9.5) and 0.88 (95% CI, 0.75–1.02), respectively. CONCLUSION: Fetal CNS anomalies are associated with higher rates of cesarean delivery. Variable prognosis exists with myelomeningocele, and additional data is needed to determine the optimal mode of delivery. Anencephaly, on the other hand, is considered a lethal diagnosis. While cesarean rates were lower in this cohort, our findings suggest that palliative birth availability and mode of delivery requires additional study for this condition.