Outcome of Antenatally Diagnosed Fetal Anterior Abdominal Wall Defects from a Single Tertiary Centre

Abstract

Objective: The aim of this study was to review the outcome of all cases of antenatally diagnosed anterior abdominal wall defects at a single tertiary centre. Method: 41 cases from the database of the Centre of Fetal Care at Queen Charlotte’s and Chelsea Hospital in London from 2000 to 2005 were reviewed and both obstetric and neonatal data were collected. Results: 25 cases were exomphalos (61%), 9 were gastroschisis (22%), 6 were body stalk anomaly (15%) and 1 case was cloacal exstrophy (2%). 17 cases (41%) were associated with other major malformations and 4 (10%) were aneuploid. There was 1 case of intrauterine death (2%). Termination of pregnancy was performed in 24 cases (63%). Of the cases that continued (exomphalos and gastroschisis), all babies survived surgery and were discharged home. Conclusions: This study demonstrates a high termination rate for fetuses diagnosed with anterior abdominal wall defects. However, the surgical outcome for euploid neonates with isolated exomphalos or gastroschisis appears to be good. Babies with gastroschisis required a longer period of parenteral feeding compared with babies with exomphalos. These infants however had a longer duration of hospitalization.

Outcome of fetal exomphalos diagnosed at 11–14 weeks of gestation

“…The results of a literature search on the incidence of chromosomal abnormalities in pregnancies with exomphalos, which ranged from 10% to 67%, are summarized in Table S15–37.…”

“…The association of exomphalos with chromosomal abnormalities and congenital heart defects6, 7 means that prenatal diagnosis usually leads to an offer of fetal karyotyping. However, most published studies on which counseling and advice are based have either focused on exomphalos diagnosed in the second trimester or failed to describe pregnancy outcomes according to the gestational age at diagnosis (Table S1)5–37. Since the natural history of exomphalos changes significantly with early diagnosis, it is inappropriate to refer to second‐trimester outcome data in counseling a woman found to have a fetus diagnosed with exomphalos in the first trimester.…”

Challenges and outcomes of management of anterior abdominal wall defects in a Nigerian tertiary hospital

“…[1,4,5] However, controversy remains regarding aetiology, anatomy and embryology, the role of prenatal diagnosis and mode of delivery, as well as initial management. [6] In developing countries, anterior abdominal wall (AAW) anomalies still pose a challenge of diagnosis and management among healthcare givers, especially in complicated cases. [2,7] This may arise due to uncommon presentation of such cases in the peripheral health centres where a majority of children are delivered.…”

Abdominal wall malformations in a 15‐year fetopathological study: accuracy of prenatal ultrasonography diagnosis

“…Magnetic resonance imaging (MRI) has played an increasingly important role in predicting the prognosis of gastroschisis (Ginsberg et al , 1997; Barisic et al , 2001). Indeed, MRI volumetry has offered an opportunity to determine the so‐called exteriorized ratio (volume of the abdomen/volume of organs outside the abdominal cavity) (Takada et al , 2006; Kumar et al , 2008), which also allows for assessing the chances of postnatal surgical intervention (Duncan et al , 2005; Arnaotoglu et al , 2008).…”