Optimal delivery method for the fetus with meningomyelocele

Background. MMC is a congenital anomaly which leaves the spinal cord and nerve roots exposed through a bony defect in the spine, leaving infants at risk for infection, death, and paralysis.; Objectives. To determine if prelabour Cesarean section (CS) is preferable to trial of labour (TOL), and if CS after TOL is preferable to vaginal birth (VB) for infants with MMC.; Design. Retrospective cohort study.; Methodology. Cases were identified at the birth hospital through a medical records search for infants born with the ICD-9 code 741 for spina bifida and then tracked to neurosurgical centres. Birth and neurosurgical data were collected on infants born with MMC over a 10 year period in Ontario.; Results. 370 infants with MMC were identified. After exclusions (n = 89) and incomplete follow-up (n = 62), 219 remained (20 died in the birth hospital). Prelabour CS was associated with a lower risk of infection than TOL (8/46 (17.4%) vs 51/150 (34.0%), odds ratio (95% CI): 0.41 (0.18-0.94)). CS after TOL was associated with a higher mortality rate at 6 months of age than VB (10/43 (23.3%) vs 12/116 (10.3%), odds ratio (95% CI): 2.63 (1.04-6.63)).; Conclusions. Although delivery by prelabour CS appears beneficial for the fetus with MMC, further analyses of the data, controlling for confounding variables, are required to confirm these findings.