Gastroschisis: can prenatal sonography predict neonatal outcome?

Gastroschisis is associated with significant neonatal morbidity, and occasionally mortality. Previous studies looking at ways to prognosticate this condition by antenatal ultrasound have shown conflicting results. The aim of this study was to evaluate the usefulness of prenatal sonographic parameters to predict neonatal outcome of gastroschisis.

The charts, photographs, and videotapes of all fetuses with gastroschisis who were assessed during pregnancy at the Mater Mothers' Hospital, Brisbane over an 8.5-year period (Jan 1993-May 2001) were reviewed. Adverse neonatal outcome was defined as death, severe bowel complications (atresia, perforation, necrotic segments), need for multiple bowel operations, or a combination of these. Various sonographic parameters assessed included: gestation at first diagnosis, maximum bowel diameter, maximum bowel wall thickness, presence of other anomalies, evidence of growth restriction, and polyhydramnios.

Forty-five patients met the entry criteria during the study period. Six neonates died, 12 had severe bowel complications, and 15 had a combination of the adverse outcomes. Polyhydramnios was most significantly associated with severe bowel complications, with a likelihood ratio of 11.7 (P = 0.001). Other ultrasound parameters were not significantly correlated with neonatal outcome.

Most standard ultrasound parameters assessed antenatally in fetal gastroschisis were not significantly associated with adverse neonatal outcome, except for polyhydramnios, which was strongly predictive of severe bowel complications in the neonatal period. This information is important both for parents and for health professionals managing pregnancies with fetal gastroschisis.