JOURNAL ARTICLE
META-ANALYSIS
SYSTEMATIC REVIEW
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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 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.

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