| 20040308-17 Elective cesarean delivery and
long-term motor function or ambulation status in infants with
meningomyelocele - Obstetrics and Gynecology , vol 103, no 3, March 2004, pp
469-473 Lewis D; Tolosa JE; Kaufmann M; et
al - (2004) |
| |
OBJECTIVE: To determine if elective cesarean
delivery, when compared with trial of labor, is associated with better
long-term motor function or ambulation status in infants with
myelomeningocele. METHODS: This is a retrospective cohort study of
patients with myelomeningocele followed at the Spinal Dysfunction Program
at Alfred I. duPont Hospital for Children in Wilmington, Delaware. Medical
records were reviewed for gestational age at delivery, birthweight,
anatomical level of lesion, and initial (0-6 months) and long-term (10
years or longer) motor function. Ambulation status (independent
ambulation, ambulant with assistance, or wheelchair-bound) at 2 and 10
years was compared with those delivered by elective cesarean versus those
delivered after trial of labor. RESULTS: Of the 106 patients with
myelomeningocele that were identified, 87 (82%) had all the data required
for this review. There were 44 patients in the elective cesarean group and
43 in the trial of labor group. There was no significant difference in
gestational age at delivery or birthweight between the groups. There was
statistical difference between the 2 groups when anatomical, initial, and
current motor levels were compared. Compared with the elective cesarean
group, patients in the trial of labor group were more likely to be
ambulatory at 2 years (independently ambulant 7% versus 28%, ambulant with
assistance 63% versus 65%, or wheelchair-bound 30% versus 7%, P =.003) and
at 10 years (independently ambulant 5% versus 21%, ambulant with
assistance 30% versus 54%, or wheelchair-bound 65% versus 25%, P
<.001). However, when logistic regression analysis was used to control
for motor level of myelomeningocele, no significant association was
observed in ambulatory status at ages 2 and 10 years between infants
delivered by elective cesarean or after trial of labor. CONCLUSION:
Elective cesarean delivery, when compared with delivery after trial of
labor, was not associated with better motor function or ambulation status
in myelomeningocele patients. (13 references)
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