The importance of serial biophysical assessment of fetal wellbeing in gastroschisis

Abstract

Objective To review antenatal and intrapartum assessment of pregnancies complicated by gastroschisis. Design Retrospective descriptive study. Setting University College Hospital, London. Subjects 24 consecutive cases of gastroschisis between 1986 and 1991. Results The gestational age at sonographic diagnosis was 20.3 weeks (SD 6.77) and at birth was 36.5 weeks (SD 2.06). There were 21 live births, all with good surgical outcome. There were 16 vaginal deliveries and eight caesarean sections. The elective sections were for oligohydramnios and dilated bowel (1) and clinically suspected growth retardation (1); the intrapartum caesarean sections were for fetal distress (4) and premature breech presentation (2). There were six with dilated gut on ultrasound; one of these ended in a stillbirth. There was a significant association between gut dilatation and caesarean section for fetal distress (P= 0.004). There was also a significant association between meconium staining and fetal distress (P= 0.021). Of these babies, 46% were ≤ third centile for corrected birth weight. Conclusions While half of the babies with gastroschisis were small for gestational age at birth, reliable antenatal prediction of birth weight is difficult. Gut dilatation may be an indicator of either antenatal or intrapartum fetal distress, but does not correlate with poor neonatal surgical outcome. We suggest close antenatal surveillance of fetal wellbeing in all cases of gastroschisis because, in addition to growth retardation, many show some evidence of fetal distress and 12.5% end in stillbirth, even when appropriately grown.

The Fetus With Gastroschisis Managed by a Trial of Labor: Antepartum and Intrapartum Complications

“…Patients who underwent a CS for fetal distress had a higher rate of induction of labor and their infants had a lower birth weight compared with women that underwent vaginal delivery. Fries et al 10 and Crawford et al 6 showed that fetuses with lower birth weights had a trend toward an increased rate of CS. In an attempt to analyze the characteristics of fetal distress in fetuses with gastroschisis, Ingamells et al 9 analyzed the computerized cardiotocography findings in 18 fetuses with gastroschisis.…”

“…These were attributed to hypoxemia. Crawford et al 6 reported baseline tachycardia as the typical abnormality in the fetal heart rate. The observation of an increased incidence of fetal distress is indirectly supported by the high rate of unexplained intrauterine deaths and stillbirths in fetuses with gastroschisis.…”

“…Indications for CS were markedly dilated bowel or a large amount of exteriorized bowel in four of six patients and breech presentation and fetal distress in one patient each. Crawford et al 6 reported that 6 of 12 women who went into spontaneous labor were delivered by CS. Fetal distress was the indication in four women and breech presentation in two.…”

“…The observation of an increased incidence of fetal distress is indirectly supported by the high rate of unexplained intrauterine deaths and stillbirths in fetuses with gastroschisis. 6,8 Growth restriction is a common finding in fetuses with gastroschisis. 2,3 We antenatally diagnosed IUGR in 50% of patients and confirmed its presence after delivery in 30% of patients.…”

“…6 Data regarding the success rate of a trial of labor are currently limited. Since 1988, we have advocated a trial of labor for all patients with gastroschisis delivered in Barnes-Jewish Hospital in St. Louis.…”