761: Fetal Gastroschisis: What is the Optimal Gestational Age for Delivery?

Decision analytic model to examine the trade-off between neonatal morbidity and mortality with intrauterine fetal demise (IUFD) for women with fetal gastroschisis in order to determine the optimal gestational age for delivery. A decision analytic model was created to compare delivery at 34 through 38 weeks gestation. At each gestational age, we accounted for different delivery strategies: (1) empiric steroids; (2) steroids if testing for fetal lung maturity (FLM) was negative; (3) wait a week and retest if FLM negative; or (4) deliver immediately. Literature review identified composite estimates for IUFD (3.7%) and neonatal death (4.65%) in the setting of fetal gastroschisis. Large cohort data were used to calculate the rates of RDS, NEC and CP by gestational age. We assumed a population of 10,000 women with a fetus with gastroschisis and maternal and neonatal quality-adjusted life years (QALYs) were combined. Univariate sensitivity analysis was performed to test for robustness. Immediate delivery at 37 weeks with no FLM testing and no steroid administration was the optimal strategy, at an incremental gain of 0.037 QALYs for the cohort as compared to delivery at 38 weeks without amniocentesis and no steroids and an incremental gain of 0.042 QALYs as compared to immediate delivery at 36 weeks. Sensitivity analysis demonstrated that our results were robust. Table 1 describes the clinical outcomes.Tabled 1 Immediate delivery at 37 weeks gestation is the optimal delivery strategy for women with fetal gastroschisis.