Should We Measure Fetal Omphalocele Diameter for Prediction of Perinatal Outcome?

Abstract

Objective: To evaluate the fetal omphalocele diameter/abdominal circumference ratio (OD/AC) as a predictor of adverse perinatal outcome. Methods: Analysis involving 47 singleton pregnancies with fetal omphalocele, normal karyotype and absence of other major abnormalities. The OD/AC ratio was determined antenatally by ultrasound and the best cutoff for the prediction of neonatal death was determined by receiver operating characteristic curve analysis. Additional secondary outcomes included need for oral intubation in the first 24 h of life, two-step surgery or use of synthetic mesh, reoperation, parenteral feeding and need for respiratory assistance >21 days, time to first oral feed, and time to hospital discharge. Results: Fetal OD/AC did not change significantly with gestational age. Postnatal death occurred in 10 (21.3%) cases and the best cutoff for prediction was an OD/AC ratio ≥0.26. In pregnancies with the first ultrasound evaluation performed before 31 weeks' gestation and an OD/AC ≥0.26, the likelihood ratio for needing intubation in the first 24 h of life was 2.6 (95% CI: 1.2-5.7), needing two-step surgery or use of mesh was 4.9 (95% CI: 1.9-14.4), and postnatal death was 4 (95% CI: 1.9-7.5). Conclusion: A fetal ultrasound OD/AC ratio ≥0.26 is associated with increased postnatal morbidity and mortality.

The validity of the viscero‐abdominal disproportion ratio for type of surgical closure in all fetuses with an omphalocele

“…In line with our finding, Kleinrouweler et al also found a decreasing OC/AC ratio with increasing GA, which resulted in different cut‐offs per GA . Kiyora et al and Montero et al, however, found no difference in ratios per GA. The latter study used fetal growth parameters (AC, femur length, and head circumference), which remained relatively constant throughout gestation.…”

“…The latter study used fetal growth parameters (AC, femur length, and head circumference), which remained relatively constant throughout gestation. The suggested ratios resulted in a lower predictive value for the prediction of postnatal closure (AUC 0.67–0.72) than the OC/AC ratio in our study (AUC 0.96–0.98), as did all ratios including omphalocele diameter instead of circumference . Additional research should make clear whether correction for GA could result in a constant cut‐off throughout gestation, without negatively affecting the predictive value.…”

“…Today, around 90% of omphaloceles and most of the additional anomalies are detected by prenatal ultrasound from 11 week gestation onwards . Previous studies have shown that ultrasound parameters can predict postnatal outcome in fetuses with an omphalocele . More recent studies showed that the ratio between the omphalocele circumference (OC) and the abdominal circumference (AC)—the OC/AC ratio—predicts the method of postnatal surgical closure .…”

“…2,14 Previous studies have shown that ultrasound parameters can predict postnatal outcome in fetuses with an omphalocele. [15][16][17][18][19] More recent studies showed that the ratio between the omphalocele circumference (OC) and the abdominal circumference (AC)-the OC/AC ratio-predicts the method of postnatal surgical closure. 17,20 These studies were mostly limited to single measurements and infants whose omphalocele was assumed to be isolated at prenatal ultrasound.…”

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

“…The latter informs them in depth about the postnatal outcome [15,17,18]. While prenatal indicators of a successful primary closure are known, so far there are no guidelines to individualize counseling about postnatal prognosis [4,8,15,19,20,21,22,23,24]. Consequently, the full spectrum of postnatal morbidity is discussed.…”