Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis.

التفاصيل البيبلوغرافية
العنوان:	Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis.
المؤلفون:	Packer CH; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Pilliod RA; Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA.; Department of Maternal Fetal Medicine, Allina Health, Minneapolis, Minnesota, USA., Caughey AB; Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA., Sparks TN; Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.
المصدر:	Prenatal diagnosis [Prenat Diagn] 2023 Nov; Vol. 43 (12), pp. 1506-1513. Date of Electronic Publication: 2023 Oct 19.
نوع المنشور:	Journal Article; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural
اللغة:	English
بيانات الدورية:	Publisher: Wiley Country of Publication: England NLM ID: 8106540 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-0223 (Electronic) Linking ISSN: 01973851 NLM ISO Abbreviation: Prenat Diagn Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Chichester, [Sussex]; New York : Wiley, c1981-
مواضيع طبية MeSH:	Gastroschisis* , Perinatal Death* , Respiratory Distress Syndrome, Newborn*, Pregnancy ; Female ; Infant, Newborn ; Humans ; Infant ; Stillbirth ; Fetus ; Ultrasonography, Doppler/methods ; Gestational Age ; Fetal Growth Retardation ; Decision Support Techniques
مستخلص:	Objective: Our objective was to determine the optimal timing of delivery of growth restricted fetuses with gastroschisis in the setting of normal umbilical artery (UA) Dopplers. Methods: We designed a decision analytic model using TreeAge software for a hypothetical cohort of 2000 fetuses with isolated gastroschisis, fetal growth restriction (FGR), and normal UA Dopplers across 34-39 weeks of gestation. This model accounted for costs and quality adjusted life years (QALYs) for the pregnant individual and the neonate. Model outcomes included stillbirth, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), short gut syndrome (SGS), neonatal sepsis, neonatal death, and neurodevelopmental disability (NDD). Results: We found 38 weeks to be the optimal timing of delivery for minimizing overall perinatal mortality and leading to the highest total QALYs. Compared to 37 weeks, delivery at 38 weeks resulted in 367.98 more QALYs, 2.22 more cases of stillbirth, 2.41 fewer cases of RDS, 0.02 fewer cases of NEC, 1.65 fewer cases of IVH, 0.5 fewer cases of SGS, 2.04 fewer cases of sepsis, 11.8 fewer neonatal deaths and 3.37 fewer cases of NDD. However, 39 weeks were the most cost-effective strategy with a savings of $1,053,471 compared to 38 weeks. Monte Carlo analysis demonstrated that 38 weeks was the optimal gestational age for delivery 51.70% of the time, 39 weeks were optimal 47.40% of the time, and 37 weeks was optimal 0.90% of the time. Conclusion: Taking into consideration a range of adverse perinatal outcomes and cost effectiveness, 38-39 weeks gestation is ideal for the delivery of fetuses with gastroschisis, FGR, and normal UA Dopplers. However, there are unique details to consider for each case, and the timing of delivery should be individualized using shared multidisciplinary decision making. (© 2023 John Wiley & Sons Ltd.)
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معلومات مُعتمدة:	R01HD107190 United States NH NIH HHS
تواريخ الأحداث:	Date Created: 20231019 Date Completed: 20231120 Latest Revision: 20240306
رمز التحديث:	20240306
DOI:	10.1002/pd.6452
PMID:	37853803
قاعدة البيانات:	MEDLINE

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تدمد:	1097-0223
DOI:	10.1002/pd.6452