Document Detail


Elective cesarean delivery and long-term motor function or ambulation status in infants with meningomyelocele.
MedLine Citation:
PMID:  14990408     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. LEVEL OF EVIDENCE: II-2
Authors:
Dawnette Lewis; Jorge E Tolosa; Marion Kaufmann; Michael Goodman; Catherine Farrell; Vincenzo Berghella
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  103     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-01     Completed Date:  2004-04-08     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  469-73     Citation Subset:  AIM; IM    
Affiliation:
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA. DAML2@aol.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cesarean Section*
Child
Child, Preschool
Female
Follow-Up Studies
Gait / physiology*
Humans
Meningomyelocele / physiopathology*
Motor Activity / physiology*
Pregnancy
Retrospective Studies
Surgical Procedures, Elective*
Time Factors
Trial of Labor*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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