Vaginal Delivery in Cases of Prenatally Diagnosed Omphalocele: Feasibility and Outcomes.

OBJECTIVE

This study aimed to assess outcomes of fetuses with prenatally detected omphalocele and the frequency of successful vaginal delivery in pregnancies with suspected non-lethal omphalocele and intended active neonatal management and its impact on neonatal outcome.

METHOD: Prenatally diagnosed omphalocele cases in Amsterdam UMC from January 2007 to January 2023 were selected. Ultrasound data including the omphalocele circumference/abdominal circumference (OC/AC) ratio were collected and perinatal data were obtained for liveborn cases.

RESULTS

A total of 225 cases were included, with a live birth rate of 20.0% (45/225). Of the suspected non-lethal cases with active neonatal management, vaginal delivery was pursued in 78.9% (30/38), of which 76.7% (23/30) succeeded. The rate of giant omphaloceles did not differ significantly between vaginal and caesarean deliveries, nor did the rate of nulliparity, maximum OC/AC ratio, extracorporeal liver on prenatal ultrasound and successful primary closure. Intrapartum sac rupture occurred in 13.0% (3/23) of successful vaginal deliveries, which was not associated with the OC/AC ratio and in none of the cases with cesarean section. Birth dystocia of the abdomen occurred in none of the cases.

CONCLUSION

In cases of intended vaginal delivery, 76.7% of vaginal deliveries succeeded, even in cases with giant omphalocele, of which the majority did not experience perinatal complications. Therefore, vaginal delivery appears to be a feasible option in cases with prenatally diagnosed omphaloceles.