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Antenatal fetal surveillance in pregnancies complicated by fetal gastroschisis
Craig V Towers1, Margaret H Carr
1Division of Maternal-Fetal Medicine, Long Beach Memorial Women's Hospital, Long Beach, CA, USA. drtowers@rbcpress.com
Insights
Antenatal fetal surveillance may be beneficial for pregnancies with fetal gastroschisis, starting around 28-29 weeks gestation. This monitoring can help prevent stillbirths and fetal acidosis, improving neonatal outcomes.
Area of Science:
- Maternal-Fetal Medicine
- Neonatalogy
- Obstetrics
Background:
- Gastroschisis is a congenital defect with potential for significant fetal compromise.
- Optimal timing for antenatal surveillance in gastroschisis pregnancies remains debated.
Purpose of the Study:
- To evaluate the necessity and optimal gestational age for antenatal fetal surveillance in gastroschisis pregnancies.
- To assess the impact of antenatal surveillance on fetal compromise and neonatal outcomes.
Main Methods:
- Retrospective review of 84 pregnancies with fetal gastroschisis over 18 years.
- Data collected included gestational age at delivery, birthweight, and neonatal outcomes.
- Fetal compromise defined as stillbirth or severe cord blood gas acidosis (pH < 7.10).
Main Results:
- No stillbirths or severe acidosis occurred in 58 pregnancies with antenatal surveillance.
- In contrast, 2 stillbirths and 2 cases of severe acidosis occurred in 26 pregnancies without surveillance.
- Abnormal surveillance results led to delivery in 38% of monitored cases.
Conclusions:
- Antenatal fetal surveillance is recommended for gastroschisis pregnancies, commencing at 28-29 weeks gestation.
- Surveillance may reduce the incidence of stillbirth and fetal acidosis.
- Testing before 28 weeks is considered controversial due to viability concerns.
Objective:
The purpose of this study was to determine if antenatal fetal surveillance should be considered in pregnancies complicated by fetal gastroschisis, and if so, what gestational age should testing begin.
Study Design:
During an 18-year period, all pregnancies delivered of a newborn that had gastroschisis were identified. Numerous data parameters were collected, including gestational age at delivery, birthweight, indication for delivery, antenatal testing results if performed, and neonatal outcome. Fetal compromise was defined as stillbirth or moderate to severe arterial cord blood gas acidosis at the time of delivery (pH < 7.10).
Results:
During the study period, 84 pregnancies complicated by fetal gastroschisis were delivered from 117,564 gestations. Antenatal testing was performed in 58 cases (69%). Of the 26 (31%) without antenatal testing, 17 had an antenatal diagnosis of gastroschisis and in 9, the diagnosis was made on the day of delivery. In the 17 with an antenatal diagnosis, there were 2 stillbirths (29(4/7) and 31(3/7) weeks' gestation) and 1 was delivered with a moderate to severe arterial cord blood gas acidosis at 29(5/7) weeks' gestation. An additional case of moderate to severe arterial cord blood gas acidosis occurred in the 9 cases where the diagnosis was made on the day of delivery. Of the 58 pregnancies with antenatal surveillance, there were no stillbirths and no cases with a moderate to severe arterial cord blood gas acidosis. Of these 58 cases, 22 (38%) were delivered based on an abnormal testing result. Of the 84 total cases, 32 (38%) had birthweights < 10th percentile, and of these, 16 (19%) had birthweights < 3rd percentile.
Conclusion:
Based on these data, antenatal fetal surveillance may be warranted in pregnancies complicated by fetal gastroschisis beginning at a gestational age of 28 to 29 weeks. Fetal testing between the thresholds of viability up to 28 weeks' gestation would be controversial.
