Secondary bladder herniation in isolated gastroschisis justifies increased surveillance

Abstract

Objectives To assess the perinatal outcome of fetuses with gastroschisis complicated by secondary bladder herniation.Population and materials This was a retrospective study of all cases of isolated gastroschisis associated with bladder herniation managed at our institution. Prenatal ultrasound, obstetrical and perinatal information were collected. Pathology reports were also gathered. ResultsOut of 105 cases of gastroschisis managed at our institution, six (5.7%) were associated with secondary bladder herniation, two of them being diagnosed postnatally. Median gestational age at diagnosis of bladder herniation was 33.6 weeks (range 31-36) in five female and one male fetuses. Bladder herniation was associated with bowel dilatation in four cases (67%) and with pyelic dilatation in one case (17%). Despite increased surveillance, one male fetus died in utero. In four other cases, cesarean section was performed for fetal distress (three cases) or hyperechogenic bowels (one case). The five survivors had primary abdominal closure (n = 2) or staged repair (n = 3) with uneventful follow-up.Conclusion Bladder herniation was present in 6% of apparently isolated gastroschisis. There was one intrauterine fetal death and four other cases were delivered for fetal distress. Increased surveillance seems justified.

Gastroschisis is a defect of the Umbilical ring: Evidence from Morphological evaluation of stillborn fetuses

“…As would be expected with this mechanism, additional bladder herniation seems to increase the risk of fetal demise (Mousty et al, ), and the frequent finding of an eviscerated bladder (observed in two of our cases) renders further support to our hypothesis that organs herniate through the umbilical ring in GS. The allantois, an extension of the bladder, normally exits through the umbilical ring into the cord and it is unlikely that the bladder would extrude through a hole different from the one containing its extension.…”

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

“…The majority of MFM specialists in our study began testing at 32 weeks (68%; 89/131), which is consistent with retrospective reviews in the literature [6-9]. This timing may be secondary to minimal change noted in the bowel until 30–32 weeks, after which time more rapid changes can be seen [20].…”

“…Monitoring often begins with monthly ultrasounds until 30–32 weeks of gestation, after which time the frequency of testing increases to either weekly or even biweekly [6-9]. The main forms of testing include Doppler ultrasound of the umbilical artery, biophysical profile (BPP), and nonstress test (NST) [10].…”

Association of spontaneous labor onset with neonatal outcomes in pregnancies with fetal gastroschisis: A retrospective cohort analysis

“…However, bladder herniation is a rare event that seems to be related to fetal distress in our study population. Mousty et al also suggested that fetuses with gastroschisis and bladder herniation should be monitored due to the increased frequency of fetal distress.…”