Fetal abdominal wall defects in an Australian tertiary setting: contemporary characteristics, ultrasound accuracy and outcome PurposeIn this study we aimed to comprehensively evaluate risk factors, ultrasound estimation of fetal weight, prenatal management and pregnancy outcomes of gastroschisis and omphalocele at a metropolitan Australian hospital. Material and MethodsThis was a retrospective single centre cohort study from 2006 to 2014 at a tertiary hospital with co-located neonatal surgical facilities. Demographic, pregnancy, ultrasound, birth and neonatal data were compared between gastroschisis and omphalocele. Correlation between routine (Hadlock 1&2) and specific (Siemer) estimated fetal weight (EFW) estimation formulae with birth weight (BW) was made for those 50 cases with ≥2 third trimester scans and last scan ≤2 week prior to birth. ResultsThere were 126 abdominal wall defects: 83 gastroschisis and 43 omphalocele.Consistent with international literature, average maternal age was lower for gastroschisis and rates of smoking higher, while there were more intrauterine deaths and pregnancy terminations in omphalocele. Gastroschisis mothers were more likely living outside Sydney, had more infections in pregnancy and were followed with a larger number of antenatal visits, with a shorter period from last visit to birth. In omphalocele pregnancies amniocentesis were more likely performed, with more abnormal results than in gastroschisis fetuses. All EFW formulae had good correlation between Z score for last US and actual BW (ICC 0.693-0.815), with Hadlock 2 being the best. Siemer formula had the best correlation from first to last scan. Gastroschisis newborns were born earlier (36.8 vs. 38.2 wks. P=0.001), with smaller birthweight (2.52 vs. 3.03 kg, p<0.001), a longer request of intensive care (central line, parenteral nutrition, intubation) and second surgery, along with more multisystem complications (average 1.5 vs. 0.7, p=0.004) and a longer hospital stay (58.8 vs. 36.8 days, p<0.001). ConclusionDemographic, antenatal and pregnancy outcome data for abdominal wall defects correlated well with the international literature. Hadlock 1-2 gave most consistent EFW estimate, all formulae showing good correlation.
prenatal detection of major congenital malformations and thereby ensure the best conditions for the baby and the parents. followed by LTAU in week 18+0 to 20+6. Anatomic structures were evaluated according to the same check-list. How well the check-list could be completed with LTAU was compared both with the check-list after ETVU and with the combination of both check-lists. McNemars X 2 test was used for analysing of data. Results:The rate of visualisation of the whole check-list by ETVU was 69% compared with 59% by LTAU. The difference was not significant (p>0,25). The combination of ETVU and LTAU increased the proportion of complete anatomy scans according to the check-list from 59% to 91% (p<0,005). Combination of ETVU and LTAU increased the proportion of fully examined structures: head/brain from 85% to 96% (p<0,005), heart from 70% to 94% (p<0.005) and for the kidneys 82% to 98% (p=0,012).Three of four anomalies were detected already during ETVU: two cases of single umbilical artery and a complex heart anomaly (VSD/TGA/DORV). The complex heart anomaly could not be verified with repeated scannings until gestational week 34+2. The fourth anomaly, Potter syndrome II, was missed by both scans. Conclusions: By means of high resolution transvaginal probe and use of 3D-tehnique and Colour Doppler it is possible to scrutinise fetal anatomy in detail as early as gestational week 13+0. The addition of an early transvaginal ultrasound at weeks 13+0 to 14+6 to LTAU at week 18+0 to 20+6 improves fetal anomaly screening in obese pregnant women, particularly with regard to the brain, the heart, and the kidneys. Objectives: To evaluate risk factors, ultrasound growth evaluation, prenatal management and pregnancy outcomes of gastroschisis (GS) and omphalocele (OMP) at a metropolitan Australian hospital. Methods: Retrospective single centre cohort study from 2006 to 2014 at a tertiary hospital co-located with neonatal surgical facilities. Demographic, pregnancy, ultrasound, birth and neonatal data were compared between GS and OMP. Correlation between routine (Hadlock 1&2) and specific (Siemer) fetal weight (FW) estimation formulae from first and last scans, with birthweight (BW) was made for those 36 cases with ≥2 third trimester scans and last scan≤1 week prior to birth. Results: There were 83 GS and 43 OMP. Average maternal age was lower in GS (26 vs 33 p<0.001), gravidity was higher in OMP (1.7 vs 1.2 p 0.08). Antenatally, there were more intrauterine deaths (14 vs 1% p 0.01) and pregnancy terminations in OMP (22.5 vs 6.2% p 0.01). More antenatal steroids were used in GS (30 vs 14% p 0.07), who were born earlier (36.7 vs 38.2wk p 0.001) and of smaller birthweight (2.52 vs 2.96kg, p=0.01). Postnatally, GS had higher rates of reintervention (46 vs 23 % p 0.02), sepsis (32 vs 13% p 0.046), and longer hospital stay (37 vs 8 days p <0.001). FW formulas had good correlation last scan to birth, moderate correlation 1st scan to birth (table 1). Conclusions: Demographic, antenatal and pregnancy outcome data of OMP and GS was si...
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