Gastroschisis: can sonography of the fetal bowel accurately predict postnatal outcome?

Abstract

To determine whether prenatal sonographic features of the small bowel can accurately predict postnatal outcome in fetuses with gastroschisis, the sonograms of 24 fetuses with prenatally detected gastroschisis were retrospectively reviewed for fetal bowel features including small bowel dilatation and bowel wall thickening. To identify a relationship between the sonographic features and neonatal outcome, each feature was analyzed against eight adverse clinical outcome measures including bowel obstruction or atresia, necrosis, and need for bowel resection, using chi‐square analysis and Kendall's taub correlation. When a relationship was identified, the sensitivity and specificity of the sonographic feature for predicting adverse outcome were determined. Only maximum small bowel diameter was related to postnatal bowel complications. Significantly more fetuses with a maximum small bowel diameter of greater than 11 mm (7/12) had bowel complications than did fetuses with MBD 11 mm or less (2/12) P < 0.05). Using a cutoff point of greater than 11 mm for maximum small bowel diameter, the sensitivity was 78%, specificity 66%, and positive predictive value 71% for predicting postnatal bowel complications. However, in only seven of 24 cases did the two observers make the same maximum small bowel diameter measurement, and in 14 of 24 cases their measurements differed by 2 mm or more. The observers varied sufficiently in their measurements to shift three fetuses (13%) between categories (< or = 11 mm or > 11 mm). Although a maximum small bowel diameter of 11 mm stratified our fetuses, this measurement may not be clinically meaningful.

Fetal abdominal wall defects—easy to diagnose—and then what?

“…Methods such as umbilical artery Doppler velocimetry, cardiotocography and biophysical profile, are considered to be unaffected by an abdominal wall defect and may be helpful in determining if uteroplacental insufficiency is present. Some will also measure the bowel diameter, since it has been shown that a diameter of > 1 cm is a marker of prenatal bowel damage 11,12 . However, it is important to note that this reflects the fact that gastroschisis is often associated with other gut anomalies (e.g.…”

Recreational Drug Use: A Major Risk Factor for Gastroschisis?

“…These studies have tended to be small and limited to the cases treated by one unit. Neonatal survival following the antenatal detection of gastroschisis has been reported to be as high as 92% to 94% (Babcook et al 1994), (Brun et al 1996). Follow-up studies have been carried out over a variety of time periods.…”

“…One reason for early intervention and delivery would be if bowel dilatation or wall thickening noted on antenatal ultrasound scan predicted the outcome for gastroschisis cases (Langer et al 1993). However, such findings have been shown to be poor predictors of post-natal bowel complications (Babcook et al 1994) and as preterm delivery has its own associated risks it is recommended only if there is convincing evidence that it will improve the outcome for gastroschisis cases. Burge et al (1997) suggest that gastroschisis cases are at significant risk of fetal distress that could indicate either an increased risk of intra uterine death or adverse neurological outcome.…”

“…However, a number of studies have looked at the association between the prenatal sonographic measurement of the diameter and dilatation of the small bowel and concluded that sonography cannot accurately determine the amount of bowel damage (Babcook et al 1994), except in the worst cases (Pryde et al 1994). Ultrasonography is also used to monitor the amniotic fluid volume as gastroschisis may be associated with oligohydramnios.…”

Gestion anténatale et issue postnatale des fœtus atteints de laparoschisis

“…Le taux de survie est passé de 20% en 1960 à 85-90% actuellement [38]. Dans notre série, parmi les 22 enfants opérés, trois sont décédés dans les trois premiers mois.…”