Prenatal Prediction of the Type of Omphalocele Closure by Different Medical Consultants

Abstract

Introduction: To evaluate differences between consultants of different disciplines in the prenatal prediction of the type of postnatal surgical closure of an omphalocele. Material and Methods: Twenty-one images of prenatally detected omphaloceles prior to 24 weeks of gestation were included. A standardized form provided known prenatal information and an ultrasound image for each case. Nineteen consultants were asked to assess the probability of primary closure of an omphalocele and to state which information was the most important for their assessment. Results: Primary closure (13/21 images) was predicted correctly in 5/13 images. The number of correct predictions per image ranged from 63 to 89%. The type of closure was predicted correctly in 7/8 images of cases which were not closed primarily, ranging from 58 to 84% correct predictions per image. There was no significant difference between consultants of different disciplines. Individual accuracy ranged from 10 to 62%. The consultants regarded omphalocele content as the most important information (34%) for counseling. Discussion: The consultants did not differ in their prenatal judgment of the primary closure of an omphalocele. The consultants tended to be too negative in their assessment, since 75% assessed the probability of primary closure overall to be <60%, whereas 62% of the cases were primarily closed. Omphalocele content was the most important information for the consultants' judgment.

Diagnosis and management of fetal omphalocele: a case report

“…The presence of ascites in liver hernial sac argues for a poor prognosis because of liver pathology. There are prenatal parameters that allow us to establish with certainty the postnatal prognosis in individual cases [9]. The survival of a baby suffering from omphalocele isolated, not associated with other abnormalities malformation is 60-70% [1].…”

“…The sonographic diagnosis is based on the demonstration of abdominal viscera contained by a sac into the basis of umbilical cord. Herniated organs are covered by a membrane, formed by the peritoneum and amnios [6][7][8][9][10]. Gastroschisis, on the contrary, is an abdominal wall defect (as well as omphalocele), but at ultrasound the absence of a sac covering the prolapsed organs is typical (mostly to the right of the umbilicus).…”

“…Both in the presence of polyhydramnios and oligohydramnios fetal prognosis worsens significantly. Fetal karyotype is recommended in case of a fetus with an ultrasound diagnosis of omphalocele [9].…”