National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey

Abstract

Background: Gastroschisis is an abdominal wall defect with increasing incidence. Given the lack of surveillance guidelines among maternal-fetal medicine (MFM) specialists, this study describes current practices in gastroschisis management. Materials and Methods: An online survey was administered to MFM specialists from institutions affiliated with the North American Fetal Therapy Network (NAFTNet). Questions focused on surveillance timing, testing, findings that changed clinical management, and delivery plan. Results: Responses were obtained from 29/29 (100%) NAFTNet centers, comprising 143/371 (39%) providers. The majority had a regimen for antenatal surveillance in patients with stable gastroschisis (94%; 134/141). Antenatal testing began at 32 weeks for 68% (89/131) of MFM specialists. The nonstress test (55%; 72/129), biophysical profile (50%; 63/126), and amniotic fluid index (64%; 84/131) were used weekly. Estimated fetal weight (EFW) was performed monthly by 79% (103/131) of providers. At 28 weeks, abnormal EFW (77%; 97/126) and Doppler ultrasound (78%; 99/127) most frequently altered management. In stable gastroschisis, 43% (60/140) of providers delivered at 37 weeks, and 29% (40/ 140) at 39 weeks. Discussion: Gastroschisis management differs among NAFTNet centers, although the majority initiate surveillance at 32 weeks. Timing of delivery still requires consensus. Prospective studies are necessary to further optimize practice guidelines and patient care.

Gastroschisis: Anatomic Defects, Etiopathogenesis, Treatment, and Prognosis

“…2). 63 Oligohydramnios may be related to fetal growth restriction and is a risk for cord compression, while polyhydramnios may be predictive of bowel atresia. 64 Growth restriction in fetuses with abdominal wall defects may predict increased adverse neonatal outcomes.…”

Abdominal wall defects

“…Once gastroschisis has been identified, referral to a multidisciplinary fetal center is recommended for close fetal surveillance, delivery planning, and high-level neonatal care. Though no specific guidelines for prenatal gastroschisis surveillance exist, a recent North American Fetal Therapy Network (NAFTNet) survey assessed current monitoring practices for gastroschisis among participating maternal-fetal medicine (MFM) specialists (12). In stable patients, antenatal testing with a combination of nonstress test, biophysical profile, and sonographic amniotic fluid index most commonly began at 32 weeks gestation and was repeated weekly.…”

“…The necessity of such close surveillance is related to the high incidence of spontaneous intrauterine fetal demise, which has been prospectively identified as 4.5% in fetuses with gastroschisis compared to 0.6% in non-anomalous fetuses and may be increased throughout the third trimester (13)(14)(15). Further, intrauterine growth restriction is common in gastroschisis and should be monitored closely during gestation (12).…”

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

“…Standard guidelines have yet to be established, 44,45 46,47 with some studies suggesting immediate surgical repair post delivery in the same operating room to reduce time to feeding and discharge. 48 Staged reduction with the placement of a silo should be reserved for cases when primary closure is not possible, due to the associated risks of abdominal compartment syndrome, prolonged length of stay and a higher risk of infection.…”

“…Standard guidelines have yet to be established, 44,45 but perinatal management typically involves a referral to a tertiary center with the infrastructure for perinatal gastroschisis management. The authors recommend fetal growth monitoring every 4 weeks, biophysical profile score starting at 28 to 30 weeks (depending on fetal growth) and delivery at term if no complications are present.…”