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Is complex gastroschisis predictable by prenatal ultrasound?
M Kuleva1, N Khen-Dunlop, Y Dumez
1Department of Obstetrics, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes Société Française pour l'Amélioration des Pratiques Echographiques, Paris, France.
BJOG : an International Journal of Obstetrics and Gynaecology
|October 25, 2011
Summary
Prenatal ultrasound can identify complex gastroschisis (GS) in neonates. Intra-abdominal bowel dilatation is a strong predictor of complex GS, indicating potential complications and longer hospital stays.
Area of Science:
- Perinatal medicine
- Neonatal surgery
- Medical imaging
Background:
- Gastroschisis (GS) is a congenital abdominal wall defect with variable postnatal outcomes.
- Differentiating simple GS from complex GS prenatally is crucial for management and parental counseling.
Purpose of the Study:
- To correlate prenatal ultrasound findings with postnatal outcomes in neonates diagnosed with gastroschisis (GS).
- To identify specific ultrasound markers predictive of complex GS and associated complications.
Main Methods:
- Retrospective case-control study analyzing prenatal ultrasound reports and neonatal records.
- Neonates with isolated GS were classified into 'simple' and 'complex' groups based on bowel complications.
- Prenatal ultrasound markers including bowel dilatation, small-for-gestational-age, and stomach dilatation were assessed.
Main Results:
- Survival rate was high (96.2%), with no ultrasound markers predicting mortality.
- Complex GS was associated with significantly longer parenteral nutrition duration and hospital stay.
- Intra-abdominal bowel dilatation (>6 mm) was the sole significant ultrasound predictor of complex GS (OR 4.13).
- A cutoff value of observed/expected bowel diameter of 6 predicted complex GS with 88% specificity.
Conclusions:
- Intra-abdominal bowel dilatation on prenatal ultrasound is a strong predictor of complex gastroschisis.
- Prenatal identification of complex GS can aid in planning neonatal surgical management and anticipating prolonged care.
