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

M C Tolcher; S A Shazly; A A Shamshirsaz; W E Whitehead; J Espinoza; A C Vidaeff; M A Belfort; A A Nassr

doi:10.1111/1471-0528.15342

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

BJOG. 2019 Feb;126(3):322-327. doi: 10.1111/1471-0528.15342. Epub 2018 Jul 18.

Authors

M C Tolcher¹, S A Shazly², A A Shamshirsaz¹, W E Whitehead³, J Espinoza¹, A C Vidaeff¹, M A Belfort¹, A A Nassr^{1

4}

Affiliations

¹ Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Fetal Center, Houston, TX, USA.
² Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
³ Department of Neurosurgery, Baylor College of Medicine, Texas Children's Fetal Center, Houston, TX, USA.
⁴ Department of Obstetrics and Gynaecology, Women's Health Hospital, Assiut University, Assiut, Egypt.

PMID: 29924919
DOI: 10.1111/1471-0528.15342

Abstract

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 with 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 exposure to 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% CI were calculated.

Main results: Of 201 abstracts identified in the primary search, nine studies (672 women) met the 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 to 0.38; I² = 57%). The vaginal delivery group was less likely to require a shunt or have sac disruption [odds ratio (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 exposure to 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.

Tweetable abstract: Available evidence does not support routine caesarean delivery for fetuses with open neural tube defects.

Keywords: Fetal open neural defects; mode of delivery; myelomeningocele.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Cerebrospinal Fluid Shunts / statistics & numerical data
Cesarean Section / methods
Delivery, Obstetric / methods*
Disease Management
Female
Humans
Labor, Obstetric
Meningitis / epidemiology
Meningocele*
Meningomyelocele*
Neural Tube Defects / therapy
Obstetric Labor Complications / epidemiology
Odds Ratio
Pregnancy
Walking