Prenatal imaging features and perinatal outcomes of foetal volvulus–A literature review

Abstract

Objective To conduct a review of the literature on foetal volvulus with emphasis on prenatal imaging, pregnancy characteristics and clinical outcomes. Methods A review of all published cases of foetal volvulus diagnosed prenatally and indexed in Medline, EBSCOhost, CINAHL, SOCIndex and Healthy Policy Reference Centre. Studies without antenatal sonographic signs of foetal volvulus and without a postpartum surgical diagnosis were excluded. Data were analysed for frequencies and distributions and tested for statistical significance. Results Eighty‐eight cases of foetal volvulus were identified from 58 published case reports/series. The most common ultrasound findings were dilated bowel/stomach (77.3%), polyhydramnios (30.7%) and whirlpool/snail sign (28.4%). Median gestation at diagnosis was 31.9 weeks (IQR 27–34) and mean gestation at delivery was 34.5 weeks (SD 2.8). Underlying aetiology included intestinal malrotation (15.9%), cystic fibrosis (14.8% of all cases, 32.5% of tested cases) and abnormal mesenteric fixation (12.5%). Complications included intestinal atresia (36.4%) and foetal anaemia (9.1%). The overall perinatal mortality rate was 14.5%. Conclusion Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. Intestinal malrotation and cystic fibrosis are common predisposing causes, although the majority are idiopathic. Bowel and/or gastric dilatation is by far the most common sonographic finding.

Prenatal diagnosis of fetal midgut volvulus: a case description

“…The identification of volvulus allowed for close prenatal monitoring and referral to postnatal management in a specialized pediatric center. As this case demonstrates, the survival rate of fetal midgut volvulus can be significantly improved by timely surgical intervention (13,14).…”

Sonographic findings of transient marked proximal bowel dilatation in a growth-restricted fetus at 35 weeks’ gestation

“…Clinicians encountering third-trimester fetal bowel dilatation are often confronted with the dilemma of whether or not these sonographic findings are consistent with an acute fetal intra-abdominal event, which may necessitate surgical management in an attempt to preserve potentially compromised fetal bowel, thus indicating the need for immediate delivery at times despite prematurity [1] , [2] , [3] , [4] , [5] . In contrast, nonsurgical conditions including (but not limited to): cystic fibrosis-associated meconium ileus, congenital chloride diarrhea, microvillus inclusion disease, intestinal neuronal dysplasia, and meconium plug syndrome are well established and do not merit immediate surgical intervention [6] , [7] , [8] , [9] , [10] , [11] .…”

“…The differential diagnosis of etiologies underlying the relatively infrequent third-trimester sonographic depiction of dilated fetal bowel includes (functional or mechanical) bowel obstruction, intestinal atresia, volvulus, annular pancreas, intestinal malrotation, intussusception, gastrointestinal duplications, cystic fibrosis-associated meconium ileus, congenital chloride diarrhea, microvillus inclusion disease, intestinal neuronal dysplasia, and meconium plug syndrome [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] . Fetal bowel obstruction may be associated with aneuploidy (mostly Trisomy 21 in association with esophageal or duodenal atresia), and rarely select microduplications or deletions, with a detection rate in cases of low risk of aneuploidy of 3.85% by copy number variation sequencing (CNV-seq) in contrast to 7.69% by whole exome sequencing (WES) [12] , [13] , [14] , [15] .…”

Fetal malrotation with midgut volvulus: Prenatal diagnosis and planning

“…Improvements in imaging have increased our ability to detect midgut volvulus shortly after birth and even prenatally. Intrauterine midgut volvulus has been diagnosed with presence of the sonographic “whirlpool” sign in utero [ 7 – 9 ] and is associated with preterm delivery [ 10 ] and high rates of in utero fetal demise [ 11 – 13 ]. Thus, prenatal diagnosis may help improve outcomes in malrotation with midgut volvulus.…”