(1102) Neonatal outcomes of gastroschisis births by mode of delivery in the United States

Objective: Although trial of labor (TOL) versus planned caesarean delivery (CD) has been hypothesized to influence clinical outcomes in neonates with gastroschisis, this clinical decision remains controversial. We assessed neonatal outcomes in newborns with gastroschisis based on delivery mode in a contemporary United States cohort.

Study Design:
We conducted a retrospective cohort study using population-based data from the US Natality Database on live singleton births complicated by gastroschisis from 2017 to 2022. Data was stratified by TOL versus CD. A sub-group analysis for term versus preterm neonates was performed. Cases with CD after failed TOL were included in the TOL group. Our primary outcome was composite adverse neonatal outcome, including chorioamnionitis, 5-minute Apgar score < 3, assisted ventilation use > 6 hours, surfactant use, neonatal seizures, and neonatal death. Patient characteristics were compared and logistic regression was performed to estimate adjusted odds ratios (aORs) for adverse outcomes accounting for gestational age (GA) at birth and birthweight.

Results: Of 17,104,917 births, 3,543 (0.021%) were complicated by gastroschisis. TOL was attempted in 2,433 (68.7%), while 1,110 (31.3%) reported planned CD. Compared to the planned CD group, those undergoing TOL had lower rates of preterm birth, delivered at later GA, and had higher birthweights (Table 1). TOL was associated with lower odds of composite adverse neonatal outcome (25.5% vs 31.4%, aOR 0.79). TOL was also

associated with lower odds of NICU admission (aOR 0.53) and immediate ventilation use (aOR 0.73), and higher odds of chorioamnionitis (OR 2.12) and infant transfer to a higher-level care facility (OR 1.23) (Table 2). Similar results were observed after stratification for term versus preterm neonates.

Conclusion: TOL was associated with lower composite adverse neonatal outcome compared to planned CD among pregnancies complicated by gastroschisis. This study is limited by variables of antenatal morbidity, such as fetal growth restriction and size of gastroschisis.