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Prognosis in isolated gastroschisis with bowel dilatation: a systematic review
1Maternal and Fetal Health Research Group, University of Manchester, Research Floor, St Mary's Hospital, Manchester M13 0JH, UK. clare.tower@manchester.ac.uk
Insights
Fetal gastroschisis with bowel dilatation shows no increased risk of adverse perinatal outcomes. More research is needed to confirm these findings for isolated gastroschisis prognosis.
Area of Science:
- Perinatal Medicine
- Fetal Surgery
- Neonatal Outcomes
Background:
- Gastroschisis is a congenital abdominal wall defect.
- Bowel dilatation in fetuses with gastroschisis is a common finding.
- The impact of bowel dilatation on fetal prognosis is not well understood.
Purpose of the Study:
- To systematically review the literature on the prognosis of fetuses with isolated gastroschisis and bowel dilatation.
- To compare perinatal outcomes between fetuses with and without bowel dilatation.
Main Methods:
- A systematic literature search was conducted (1980-2007).
- Studies were assessed for quality and stratified by bowel dilatation definition.
- Data on intrauterine death, neonatal death, bowel resection, time to oral feeds, and inpatient stay were extracted.
Main Results:
- 10 studies (273 patients) were included.
- No significant differences were found in neonatal death or bowel resection rates.
- Insufficient data existed for intrauterine death and time to oral feeds; inpatient stay was not significantly different.
Conclusions:
- Fetuses with isolated gastroschisis and bowel dilatation do not appear to have an increased risk of adverse perinatal outcomes.
- A significant lack of high-quality studies necessitates a randomized controlled trial.
Objectives:
To investigate prognosis of the fetus with isolated gastroschisis and bowel dilatation from a systematic review of the literature. We aimed to compare the incidence of (a) intrauterine death, (b) death within 4 weeks of delivery, (c) bowel resection, (d) length of time to oral feeds and (e) time as inpatient in fetuses with gastroschisis with and without evidence of bowel dilatation.
Methods:
Literature was identified by searching two bibliographical databases between 1980 and 2007. Studies were assessed for quality and stratified according to the definition of bowel dilatation. The data extracted were inspected for clinical and methodological heterogeneity.
Results:
The search strategy yielded 1335 potentially relevant citations. Full manuscripts were retrieved for 92 citations. 10 studies (273 patients) were finally included in the systematic review. No difference was found between groups for death within 4 weeks of delivery (OR = 0.62 (95% CI 0.11 to 3.32); heterogeneity p = 0.39) or bowel resection (OR = 3.35 (95% CI 0.82 to 13.74); heterogeneity p = 0.39). There were insufficient data to compare the risk of intrauterine death and length of time to oral feeds. The mean inpatient stay was not significantly different between groups (OR = 16.63 (95% CI 0.98 to 32.28); heterogeneity p = 0.23).
Conclusion:
Current available evidence suggests that fetuses with isolated gastroschisis and bowel dilatation are not at increased risk of adverse perinatal outcome compared to those without bowel dilatation. However, there is a paucity of studies, and a randomised controlled trial is urgently needed.
