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Fetal omphalocele and gastroschisis: a review of 24 cases
Insights
Prenatal sonography helps identify factors influencing outcomes for fetal abdominal wall defects like omphalocele and gastroschisis. Gastroschisis generally has a better survival rate due to fewer associated anomalies compared to omphalocele.
Area of Science:
- Medical Imaging
- Fetal Medicine
- Neonatal Surgery
Background:
- Fetal omphalocele and gastroschisis are congenital abdominal wall defects requiring immediate surgical intervention.
- Prenatal diagnosis is crucial for planning management and assessing prognosis.
Purpose of the Study:
- To evaluate the role of prenatal sonography in identifying prognostic factors for fetal abdominal wall defects.
- To assess the sonographic differentiation between omphalocele and gastroschisis.
- To correlate prenatal findings with neonatal outcomes.
Main Methods:
- Retrospective review of 24 cases with abdominal wall defects (16 omphalocele, 8 gastroschisis).
- Sonographic evaluation for umbilical cord insertion, defect contents, membrane presence, fetal ascites, bowel-wall thickening, and coexisting anomalies.
- Analysis of survival rates based on defect type and associated anomalies.
Main Results:
- Sonographic differentiation between omphalocele and gastroschisis was achieved in 75% of cases.
- Associated congenital anomalies were present in 88% of omphalocele cases and 50% of gastroschisis cases.
- Overall survival rate was 50% (excluding terminations); survival was 33% for omphalocele and 83% for gastroschisis.
Conclusions:
- Prenatal sonography is valuable for diagnosing and characterizing fetal abdominal wall defects.
- The lower incidence of associated anomalies in gastroschisis contributes to its significantly better survival rate compared to omphalocele.
- Early identification of prognostic indicators via prenatal ultrasound aids in optimizing neonatal surgical management.
Abstract:
Fetal omphalocele and gastroschisis are congenital defects of the abdominal wall that require prompt surgical management at the time of delivery. To evaluate the role of prenatal sonography in identifying factors that influence prognosis, 24 cases of abdominal-wall defect (16 omphalocele, eight gastroschisis) were reviewed. Sonograms were evaluated for location of umbilical cord insertion, contents of the ventral defect, presence or absence of a covering membrane, fetal ascites, bowel-wall thickening, and coexisting anomalies. Sonographic differentiation between omphalocele and gastroschisis was possible in 18 (75%) of 24 cases. Eighteen patients had congenital defects in addition to the abdominal-wall defect. Associated abnormalities were present in 14 (88%) of 16 fetuses with omphalocele and four (50%) of eight with gastroschisis. Overall survival rate was 50%, excluding six terminated pregnancies. Survival rate was 33% for neonates with omphalocele and 83% for those with gastroschisis. The better prognosis for neonates with gastroschisis appears to reflect the lower frequency of associated congenital anomalies.