C-Sections for Fetal Anomalies Under Question. (Little Evidence On Best Mode Of Delivery).

WEST PALM BEACH, FLA. -- Although many physicians consider cesarean section the standard of care for a wide variety of fetal anomalies, there is no basis for this practice in the literature, Dr. Deward Voss said at an ob.gyn. meeting sponsored by the University of Chicago.

"Many of these anomalies are so uncommon that you're not going to see randomized, prospective trials on the best route of delivery," remarked Dr. Voss, who is a maternal-fetal medicine specialist at Good Samaritan Hospital in Cincinnati.

"In the absence of well-controlled studies, cesarean section should continue to be investigated, but not considered the standard of care," he told this newspaper.

The trend toward C-section in cases of fetal anomalies may originate from what Dr. Voss believes are a few spurious assumptions in the literature that the procedure is less traumatic for the baby.

But for most anomalies there is no convincing evidence that a C-section provides neonatal benefit, and it clearly increases maternal risk and morbidity.

Fetal anomalies that may indicate delivery by C-section include monoamniotic or conjoined twins because of cord entanglement, hydrocephalus, cystic hygroma, sacrococcygeal teratomas, congenital heart block, hydrops fetalis, and skeletal dysplasia.

In all cases where the anomaly is fatal, the delivery should be vaginal because the maternal risks of C-section are too great if the baby is not going to survive anyway, according to Dr. Voss.