Optimal delivery method for the fetus with meningomyelocele

grantor: University of TorontoBackground. MMC is a congenital anomaly which leaves the spinal cord and nerve roots exposed through a bony defect in the spine, leaving infants at risk for infection, death, and paralysis. Objectives. To determine if prelabour Cesarean section (CS) is preferable to trial of labour (TOL), and if CS after TOL is preferable to vaginal birth (VB) for infants with MMC. Design. Retrospective cohort study. Methodology. Cases were identified at the birth hospital through a medical records search for infants born with the ICD-9 code 741 for spina bifida and then tracked to neurosurgical centres. Birth and neurosurgical data were collected on infants born with MMC over a 10 year period in Ontario. Results. 370 infants with MMC were identified. After exclusions (n = 89) and incomplete follow-up (n = 62), 219 remained (20 died in the birth hospital). Prelabour CS was associated with a lower risk of infection than TOL (8/46 (17.4%) vs 51/150 (34.0%), odds ratio (95% CI): 0.41 (0.18-0.94)). CS after TOL was associated with a higher mortality rate at 6 months of age than VB (10/43 (23.3%) vs 12/116 (10.3%), odds ratio (95% CI): 2.63 (1.04-6.63)). Conclusions. Although delivery by prelabour CS appears beneficial for the fetus with MMC, further analyses of the data, controlling for confounding variables, are required to confirm these findings.M.Sc