Gastroschisis. Prenatal sonographic markers and perinatal prognosis
DOI:
https://doi.org/10.31403/rpgo.v58i70Abstract
Objectives: To determine extrabadominal intestinal loop dilation and wall thickness as predictors of adverse perinatal outcomes in fetuses with gastroschisis. Design: Retrospective, observational, analytical correlation study. Setting: Fetal Surveillance Unit, Edgardo Rebagliati Martins National Hospital, EsSalud, Lima, Peru. Participants: Pregnant women with prenatal diagnosis of fetal gastroschisis. Interventions: We determined all patients with gastroschisis diagnosis from January 2008 through December 2010. Presence or absence of bowel dilatation and edema and postnatal intestinal outcome up to 6 months from birth were registered and compared with perinatal morbidity and mortality of babies without those alterations. Main outcome measures: Bowel dilation and wall edema by ultrasound. Results: According to the Registry of Fetal Surveillance Unit 19 cases of gastroschisis were found. One case was excluded because of other abnormalities present. Mean maternal age was 26.3 years and mean gestational age of pregnancy termination by cesarean section was 36.6 weeks. Eleven cases had birth weights less than percentile 10. In eight cases (44.4%) prenatal sonographic examination revealed dilated bowel loop over 20 mm diameter. No fetus died in utero. There were nine cases with intestinal complications, five with intestinal obstruction and four with intestinal perforation. Bowel obstruction occurred in 80% of cases with intestinal edema during prenatal sonographic evaluation. The positive predictive value of >20 mm dilation of intestinal loops was 0.75 for predicting intestinal complications. Four cases required re-operation. Ability to predict por postoperative evolution according to intestinal wall thickness had a sensitivity of 0.75. Stay in neonatal intensive care unit in groups with and without extra-abdominal dilatation was respectively 51.6 and 34.8 days, with significant difference. Conclusions: Ultrasonographic detection of extrabadominal intestinal loop dilatation at least three weeks before birth was predictor of intestinal complications in the postnatal period as well as neonatal ICU stay. Also wall edema correlated with surgical reinterventions of fetuses.
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Curry JI, McKinney P, Thornton JG, Stringer MD. The aetiology of gastroschisis Br J Obstet Gynaecol. 2000; 107:1339–46.
Penman DG, Fisher RM, Noblett HR, Soothill PN. Increase in the incidence of gastroschisis in the South West of England in 1995. Br J Obstet Gynaecol. 1998;105:328–31.
Ledbetter DJ. Congenital abdominal wall defects and reconstruction in pediatric surgery: gastroschisis and omphalocele. Surg Clin North Am. 2012;92(3):713-27, x.
Brantberg A, Blaas HG, Salvesen KA, Haugen SE, Eik- Nes SH. Surveillance and outcome of fetuses with gastroschisis. Ultrasound Obstet Gynceol. 2004;23:4–13.
Molik KA, Gingalewski CA, West KW, Rescorla FJ, Scherer LR, Engum SA, Grosfeld JL. Gastroschisis: a plea for risk categorization. J Pediatr Surg. 2001;36:51–5.
Contro E, Fratelli N, Okoye B, Papageorghiou A. Prenatal ultrasound in the prediction of bowel obstruction in infants with gastroschisis Ultrasound Obstet Gynecol. 2010;35:702–7.
Ergun O, Barksdale E, Ergun FS, et al. The timing of delivery of infants with gastroschisis influences outcome. J Pediatr Surg. 2005;40:424–8.
Japaraj RP, Hockey R, Chan FY. Gastroschisis: can prenatal sonography predict neonatal outcome? Ultrasound Obstet Gynecol. 2003;21:329–33.
Langer JC, Khanna J, Caco C, Dykes EH, Nicolaides KH. Prenatal diagnosis of gastroschisis: development of objective sonographic criteria for predicting outcome. Obstet Gynecol. 1993; 81:53–6.
Alsulyman OM, Monteiro H, Ouzounran JG, Barton L, Songster GS, Kovacs BW. Clinical significance of prenatal ultrasonographic intestinal dilatation in fetuses with gastroschisis. Am J Obstet Gynecol. 1996;175:982–4.
Tower C, Ong SS, Ewer AK, Khan K, Kilby MD. Prognosis in isolated gastroschisis with bowel dilatation: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2009; 94:F268–F274.
Japaraj RP, Hockey R, Chan FY. Gastroschisis: can prenatal sonography predict neonatal outcome? Ultrasound Obstet Gynecol. 2003;21:329–33.
Piper HG, Jaksic T. The impact of prenatal bowel dilation on clinical outcomes in neonates with gastroschisis. J Pediatr Surg. 2006;41:897–900.
Moir CR, Ramsey PS, Ogburn PL, Johnson RV, Ramin KD. A prospective trial of elective preterm delivery for fetal gastroschisis. Am J Perinatol. 2004;21:289–94.
Vermont Network Database. Disponible en: http://www.vtoxford.org/about/network_db.aspx. Obtenido el 8 de agosto de 2012.
Badillo AT, Hedrick HL, Wilson RD, Danzer E, Bebbington MW,Johnson MP, Liechty KW, Flake AW, Adzick NS. Prenatal ultrasonographic gastrointestinal abnormalities in fetuses with gastroschisis do not correlate with postnatal outcomes. J Pediatr Surg. 2008;43:647–53.
Heinig J, Müller V, Schmitz R, Lohse K, Klockenbusch W, Steinhard J. Sonographic assessment of the extra-abdominal fetal small bowel in gastroschisis: a retrospec tive longitudinal study in relation to prenatal complications. Prenat Diagn. 2008;28:109–14.
Payne NR, Pfleghaar K, Assel B, Johnson A, Rich RH. Predicting the outcome of newborns with gastroschisis. J Pediatr Surg. 2009;44:918–23.
Davis RP, Treadwell MC, Drongowski RA, Teitelbaum DH, Mychaliska GB. Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome? Pediatr Surg Int. 2009;25:319–325.
Aina-Mumuney AJ, Fischer AC, Blakemore KJ, Crino JP, CostiganK, Swenson K, Chisholm CA. A dilated fetal stomachpredicts a complicated postnatal course in cases of prenatally diagnosed gastroschisis. Am J Obstet Gynecol. 2004;190:1326–30.
Puligandla PS, Janvier A, Flageole H, Bouchard S, Mok E, Laberge JM. The significance of intrauterine growth restriction is different from prematurity for the outcome of infants with gastroschisis. J Pediatr Surg. 2004;39:1200–4.
Nyberg DA, Mack LA, Patten RM, Cyr DR. Fetal bowel. Normal sonographic findings. J Ultrasound Med. 1987;6:3–6.
Parulekar SG. Sonography of normal fetal bowel. J Ultrasound Med. 1991;10(4): 211–20.
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