Category: Intrapartum Fetal Assessment
Poster Session I
We found 38 weeks to be the optimal timing of delivery for growth restricted fetuses with gastroschisis and normal UA Doppler studies. This gestational age minimized overall perinatal mortality and led to the highest total QALYs. Compared to 37 weeks, delivery at 38 weeks results in 357 more QALYs, 3 more stillbirths, 11 fewer cases of NND, 3 fewer cases of NDD, and 0 fewer cases of RDS and NEC. Delivery at later gestational ages resulted in increased stillbirths. Sensitivity analyses showed that 37 weeks became the optimal gestational age for delivery if the overall risk of stillbirth increased to just over six times higher than our baseline assumptions.
Conclusion:
Taking into consideration a range of adverse perinatal outcomes, 38 weeks is the optimal and most cost-effective gestational age for delivery of fetuses with gastroschisis, FGR, and normal UA Dopplers. Future research should consider additional factors such as interval growth and abnormal UA Dopplers in this decision-making.
Claire H. Packer, MD, MPH (she/her/hers)
Resident
Brigham and Women's Hospital, Harvard Medical School
Boston, Massachusetts, United States
Rachel A. Pilliod, MD
Assistant Professor of Obstetrics and Gynecology, School of Medicine
Oregon Health and Science University
Portland, Oregon, United States
Aaron B. Caughey, MD,MPH,PhD
Professor and Chair
Oregon Health and Science University
Portland, Oregon, United States
Teresa N. Sparks, MD, MAS
Maternal-Fetal Medicine and Clinical Genetics
University of California, San Francisco
San Francisco, California, United States