Predicting Perinatal Outcome from Prenatal Ultrasound Characteristics in Pregnancies Complicated by Gastroschisis

Martillotti, Gabriella; Boucoiran, Isabelle; Damphousse, Amélie; Grignon, Andrée; Dubé, Évemie; Moussa, Ahmed; Bouchard, Sarah; Morin, Lucie

doi:10.1159/000440699

Cited by 30 publications

(43 citation statements)

References 44 publications

(50 reference statements)

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“…Therefore, in agreement with previous studies [8,12,20] , IABD must be considered a relevant US marker of CG and morbidity.…”

Section: Discussionsupporting

confidence: 88%

“…However, both cases exhibited other US markers and CG. We identified only 1 study [12] that described the presence of an echogenic extrabowel in 4 gastroschisis fetuses in the third trimester of pregnancy, and 3 cases presented CG. We agree with the authors that fetal gastroschisis with an echogenic extra-bowel should be followed up more closely.…”

Section: Discussionmentioning

confidence: 99%

“…The following US markers were analyzed and considered in the classification: extra-abdominal bowel dilatation (EABD) and EBWT expressed as the observed/expected ratio, in which the expected measurement was derived from the present study population based on a regression model adjusted for GA; the AWD size expressed as the AWD size/abdominal circumference (AC) ratio; IABD considered the cutoff value for GA periods (25-30 weeks = 12 mm; 30-35 weeks = 19 mm; 35-40 weeks = 24 mm) according to Martillotti et al [12] ; stomach dilatation was considered when the anteroposterior diameter was >2 SD from the reference nomogram [15] ; stomach herniation was defined as exteriorization of the major part of the stomach through the defect [16] ; an AC below the 5th percentile for GA [17] ; amniotic fluid volume was considered oligohydramnios and polyhydramnios when the amniotic fluid index was <5 cm and >24 cm, respectively. For the US examination shortly before delivery, we considered the US performed up to 21 days prior to delivery.…”

Section: Methodsmentioning

confidence: 99%

“…IABD was measured in 51/186 (27.42%) patients with suspected dilatation. Dilatation was based on the work by Martillotti et al [12] . The classification was identified in 13/186 (7%) patients overall, 6/126 (4.8%) patients at 25-30 weeks, 12/170 (7.1%) patients at 30-35 weeks, and no patients at 35-40 weeks of gestation.…”

Section: Us Markers and Outcomesmentioning

confidence: 99%

“…However, few studies have investigated the associations between US markers and CG [8,12] . Of these studies, intra-abdominal bowel dilatation (IABD) was theAccording to a recent meta-analysis of publications on US markers used to predict fetal gastroschisis prognosis [14] , limitations remain because the majority of the studies included small sample sizes, utilized different thresholds to define the US markers as abnormal, assessed limited outcome measures, and investigated the US markers at limited gestational ages (GAs).…”

Section: Introductionmentioning

confidence: 99%

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Sonographic Markers in the Prediction of Fetal Complex Gastroschisis

Andrade

Brizot²,

Rodrigues³

et al. 2017

Fetal Diagn Ther

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Objective: To investigate the ultrasound (US) markers predictive of complex gastroschisis (CG), mortality, and morbidity in fetuses with gastroschisis. Materials and Methods: This was a retrospective cohort study of 186 pregnancies with isolated fetal gastroschisis. Eight US markers were analyzed. The predictions and associations of US markers with CG, mortality, and morbidity were assessed. Combinations of US markers predictive of CG were investigated. Results: Extra-abdominal bowel dilatation (EABD), intra-abdominal bowel dilatation (IABD), and polyhydramnios were predictive of CG. EABD between 25 and 28 weeks had a sensitivity of 64%, a specificity of 89%, a positive predictive value (PPV) of 56.2%, and negative predictive value (NPV) of 91.8%. The predictions of IABD were sensitivity = 26.7%, specificity = 96.7%, PPV = 61.5%, and NPV = 86.8%. The odds ratios for CG in the presence of 1 and 2 US markers, compared with the absence of a US marker, were 18.3 (95% CI, 3.83-87.64) and 73.3 (95% CI, 6.14-876), respectively. Conclusion: US markers predictive of CG were established. The combination of these markers increases the probability of CG.

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“…Therefore, in agreement with previous studies [8,12,20] , IABD must be considered a relevant US marker of CG and morbidity.…”

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Us Markers and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Sonographic Markers in the Prediction of Fetal Complex Gastroschisis

Andrade

Brizot²,

Rodrigues³

et al. 2017

Fetal Diagn Ther

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What prenatal ultrasound features are predictable of complex or vanishing gastroschisis? A retrospective study

et al. 2017

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Objective To evaluate prenatal ultrasound parameters as prognostic factors for complex and vanishing gastroschisis. Methods Retrospective multicentre study of 200 gastroschisis over 13 years (2000–2013). Collection of prenatal ultrasound evaluation on maternal and fetal growth parameters, intra‐ and extra‐abdominal bowel and stomach dilation, abdominal wall defect diameter and changes in bowel appearance. Correlation of these factors with the presence of mechanical intestinal complications at birth, named ‘complex gastroschisis’. Results Fifty‐two patients (26%) had complex gastroschisis (CG), including ten vanishing gastroschisis. The presence of intra‐abdominal bowel dilation at the second (T2) or third (T3) trimester ultrasound was predictive for CG, with odds ratios at 6.69 (95%CI 2.41–18.55) and 4.72 (95%CI 2.16–10.28), respectively, with a cut‐off value at the last examination of >19 mm. A small abdominal wall defect diameter was also predictive for CG, with cut‐off values of <9.2 mm at T2 and <12.5 mm at T3. Vanishing gastroschisis recorded earlier intra‐abdominal bowel dilation diagnosis, associated with a small wall defect and no extra‐abdominal dilation. Conclusion Intra‐abdominal bowel dilation and a small abdominal wall defect diameter accurately predict CG and could be a first sign of vanishing gastroschisis when they occur early. © 2016 John Wiley & Sons, Ltd.

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

et al. 2020

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We conducted a comprehensive evidence‐based review on the epidemiology and current standard of care of gastroschisis management as well as the pathophysiology, rationale and feasibility of fetal therapy as a viable alternative. Gastroschisis is a periumbilical abdominal wall defect characterized by abdominal viscera herniation in utero. It affects 4 in 10 000 live births, but the prevalence has steadily increased in recent years. Gastroschisis is typically diagnosed on routine second‐trimester ultrasound. The overall prognosis is favorable, but complex gastroschisis, which accounts for about 10% to 15% of cases, is associated with a higher mortality, significant disease burden and higher healthcare costs due to long‐ and short‐term complications. The current standard of care has yet to be established but generally involves continued fetal surveillance and multidisciplinary perinatal care. Postnatal surgical repair is achieved with primary closure, staged silo closure or sutureless repair. Experimental animal studies have demonstrated the feasibility of in utero closure, antiinflammatory therapy and prenatal regenerative therapy. However, reports of early preterm delivery and amnioinfusion trials have failed to show any benefit in humans. Further experimental studies and human trials are necessary to demonstrate the potential benefit of fetal therapy in gastroschisis.

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Predicting Perinatal Outcome from Prenatal Ultrasound Characteristics in Pregnancies Complicated by Gastroschisis

Cited by 30 publications

References 44 publications

Sonographic Markers in the Prediction of Fetal Complex Gastroschisis

Sonographic Markers in the Prediction of Fetal Complex Gastroschisis

What prenatal ultrasound features are predictable of complex or vanishing gastroschisis? A retrospective study

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

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