Route of delivery of fetuses with structural anomalies.

Our ability to diagnose fetuses with congenital anomalies has dramatically increased over the past two decades and with improved surgical treatment for some defects, more women may choose to continue their pregnancies. Antenatal management is thus of increasing relevance. The literature on route of delivery suggests the following conclusions. Babies with neural tube defects presenting by the breech benefit from caesarean section but there is no clear evidence that cesarean improves outcome in those with a vertex presentation. When the size of the sac exceeds 6 cm, cesarean section may be justified to decrease the risk of disruption. Vaginal delivery is desirable in all other cases to reduce maternal morbidity. Cystic hygroma: cesarean section offers optimal conditions for management of large anterior lymphangiomas that can obstruct the airway. Sacrococcygeal teratoma: the current approach is based on the size of the tumor. In a fetus with a tumor of less than 5 cm, vaginal delivery may be attempted. Ventral wall defects: there is no conclusive evidence that cesarean section is beneficial for fetuses with omphalocele. Gastroschisis: because of the heterogeneity of the studies, it is difficult to assess the net impact of mode of delivery. There is no evidence of significant differences in outcome among fetuses delivered by the vaginal versus the abdominal route. Trauma to the abdominal viscera can occur during either route, and careful delivery is thus mandated.