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Surveillance and outcome of fetuses with gastroschisis
A Brantberg1, H-G K Blaas, K A Salvesen
1National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway. annebrantberg@hotmail.com
Insights
Cardiotocography (CTG) surveillance for fetuses with gastroschisis can detect fetal distress, potentially reducing intrauterine fetal death (IUFD). This monitoring helps manage high-risk pregnancies and improve infant outcomes.
Area of Science:
- Perinatology
- Fetal Medicine
- Neonatology
Background:
- Gastroschisis, a congenital anomaly, presents a significant risk of intrauterine fetal death (IUFD), often linked to fetal distress.
- While infant survival rates are high, managing prenatal risks remains crucial for optimal outcomes.
Purpose of the Study:
- To evaluate the outcomes of fetuses diagnosed prenatally with gastroschisis.
- To assess the impact of accurate prenatal diagnosis, fetal surveillance, and identification of risk factors on pregnancy outcomes.
Main Methods:
- Prospective evaluation of fetuses with prenatally diagnosed gastroschisis using serial ultrasound examinations.
- Intensive monitoring from 34-36 weeks gestation, including daily to every-other-day cardiotocography (CTG).
Main Results:
- Gastroschisis diagnosed in 64 fetuses; one intrauterine fetal death (1.6%).
- Abnormal CTG detected in 13 fetuses (22%), leading to Cesarean sections; 4 infants (6.7%) had small bowel atresia.
- Meconium-stained amniotic fluid (25%) was associated with abnormal CTG and/or small for gestational age (SGA) infants.
Conclusions:
- Cardiotocography (CTG) surveillance is vital for detecting fetal distress in gastroschisis pregnancies.
- Effective prenatal monitoring and management can potentially reduce the risk of IUFD and improve fetal outcomes.
Objectives:
Infants with gastroschisis have a high survival rate. However, the rate (10-15%) of intrauterine fetal death (IUFD) is considerable, and the association with fetal distress is well known. The aim of this study was to describe the outcome of fetuses with a prenatal diagnosis of gastroschisis. The impact of correct prenatal diagnosis, surveillance and signs of complicating risk factors were evaluated.
Methods:
All fetuses with prenatally diagnosed gastroschisis at the National Center for Fetal Medicine from January 1988 to August 2002 were registered and prospectively evaluated with regular ultrasound examinations. From 34-36 completed gestational weeks the fetuses were monitored daily to every second day with cardiotocography (CTG).
Results:
Gastroschisis was diagnosed in 64 fetuses at a mean gestational age of 19 + 2 weeks. All had normal karyotype. Associated anomalies were found in four cases (6.3%). Three pregnancies (4.7%) were terminated, all for reasons other than gastroschisis. One fetus (1.6%) died in utero. Thirteen fetuses (22%) had abnormal CTG leading to subsequent Cesarean sections. Mean gestational age at delivery was 36 + 1 weeks. Mean birth weight was 2586 g. Thirteen infants (22%) were small for gestational age (SGA). In 15 cases (25%) meconium-stained amniotic fluid was found; 14 of these had abnormal CTG and/or were SGA. Small bowel atresia was found in four infants (6.7%). Four infants died postnatally at the age of 0-9 months.
Conclusions:
CTG surveillance of fetuses with gastroschisis may improve the outcome through detection of fetal distress thereby reducing the risk of IUFD. Other clinical situations of importance that are associated with gastroschisis are described and discussed.