Neurological outcomes by mode of delivery for fetuses with open neural tube defects: A systematic review and meta-analysis.

BACKGROUND: Controversy exists regarding the optimal mode of delivery for fetuses with open neural tube defects. OBJECTIVE: To compare neurological outcomes among infants with open neural tube defects who underwent vaginal compared to caesarean delivery. SEARCH STRATEGY: Electronic databases MEDLINE, EMBASE, Scopus, and Clinicaltrials. gov were searched from inception to November 2017. SELECTION CRITERIA: Eligible studies included observational or randomised studies comparing vaginal and caesarean delivery in pregnancies with fetal open neural tube defects who did not undergo prenatal repair. DATA COLLECTION AND ANALYSIS: Two reviewers independently reviewed abstracts and full text articles. Outcomes were compared between vaginal and caesarean delivery and prelabour caesarean versus labour. The primary outcome was motor-anatomic level difference. Secondary outcomes included shunt requirement, sac disruption, meningitis, and ambulation at 2 years. Meta-analysis was performed and mean difference or odds ratios with 95% confidence interval calculated. MAIN RESULTS: Of 201 abstracts identified in the primary search, 9 studies (672 women) met eligibility criteria. Comparing vaginal and caesarean delivery, there was no significant difference in motor-anatomic level difference (mean difference -0.10, 95% CI -0.58-0.38; I2 =57%). The vaginal delivery group was less likely to require a shunt or have sac disruption (OR 0.37, 95% CI 0.14-0.95 and OR 0.46, 95% CI 0.23-0.90, respectively). Comparisons by prelabour caesarean versus labour showed no significant difference in motor-anatomic level difference (OR 1.29, 95% CI -0.63-3.21) or ambulation at 2 years (OR 2.13, 95% CI 0.35-13.12). CONCLUSION: Caesarean delivery was not associated with improved neurological outcomes among fetuses with open neural tube defects. This article is protected by copyright. All rights reserved.