Mode of delivery and outcomes of infants with gastroschisis: a meta-analysis of observational studies

Background There is controversy among the literature for electing caesarean section (CS) delivery for infants with gastroschisis in an attempt to reduce mortality and morbidity.Objective This meta-analysis investigates whether there is enough evidence to support CS delivery over vaginal delivery.Data sources We conducted our search in April 2017. We searched Cochrane, Medline, Premedline, Embase, CINAHL, GoogleScholar and Web of Science. We also searched conferences for abstracts online. Additional studies were retrieved by reviewing reference lists.Study selection Observational studies, excluding case series, were eligible if data compared relevant outcomes of infants with gastroschisis in relation to mode of delivery.Data extraction Relevant information were extracted and assessed the methodological quality of the retrieved records.Results Thirty-eight studies were included. Evidence suggested that mode of delivery is not significantly associated with overall mortality (OR 0.82, 95% Cl 0.57 to 1.18), primary repair (OR 0.82, 95% Cl 0.57 to 1.18), neonatal mortality (OR 1.08, 95% Cl 0.54 to 2.15), necrotising enterocolitis, secondary repair, sepsis, short gut syndrome, duration until enteral feeding and duration of hospital stay. Furthermore, sensitivity analyses based on economic status and quality of study showed no significant difference between the impact of mode of delivery for all investigated outcomes.Limitations Due to uncontrolled variables between and within studies, particularly regarding characteristics of delivery and postdelivery care, it is difficult to extract meaningful results from the literature.Conclusions There is insufficient evidence to advocate the use of CS over vaginal delivery for infants with gastroschisis.