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Severity of intestinal damage in gastroschisis: correlation with prenatal sonographic findings
S J Bond1, M R Harrison, R A Filly
1Department of Surgery, University of California, San Francisco 94143.
Insights
Prenatal ultrasound accurately detects abdominal wall defects like gastroschisis. Specific sonographic findings predict intestinal damage severity, guiding delivery decisions and improving infant outcomes.
Area of Science:
- Medical Imaging
- Fetal Medicine
- Pediatric Surgery
Background:
- Abdominal wall defects, including omphalocele and gastroschisis, are serious congenital anomalies.
- Accurate prenatal diagnosis is crucial for planning management and predicting outcomes.
- Previous studies have explored correlations between prenatal findings and clinical outcomes in gastroschisis.
Purpose of the Study:
- To evaluate the accuracy of obstetric ultrasound in distinguishing between omphalocele and gastroschisis.
- To correlate prenatal sonographic findings with clinical outcomes in gastroschisis.
- To identify sonographic predictors of intestinal damage severity in prenatally diagnosed gastroschisis.
Main Methods:
- Retrospective review of 26 cases of prenatally detected abdominal wall defects (1982-1986).
- Ultrasound assessment of defect type, size, and sonographic appearance of eviscerated bowel.
- Correlation of prenatal findings with clinical outcomes, including intestinal damage and morbidity/mortality.
Main Results:
- Ultrasound correctly distinguished omphalocele from gastroschisis in all live births.
- Neither defect size nor duration of amniotic fluid exposure correlated with clinical outcome.
- Prenatal sonographic presence of small bowel dilatation and mural thickening strongly correlated with severe intestinal damage and poor outcomes.
- Absence of these findings predicted mild intestinal changes and benign clinical course.
Conclusions:
- Obstetric ultrasound accurately detects abdominal wall defects and predicts gastroschisis severity.
- Specific sonographic criteria (bowel dilatation, mural thickening) indicate severe intestinal damage.
- Early delivery solely to limit amniotic fluid exposure is not recommended; focus should be on identified sonographic indicators of severity.
Abstract:
From 1982 to 1986, 26 abdominal wall defects were detected prenatally. Seventeen pregnancies culminated in live births with ultrasound correctly distinguishing between omphalocele and gastroschisis in all cases. In the 11 cases of gastroschisis diagnosed before birth, we attempted to correlate the clinical outcome with the size of the abdominal wall defect, sonographic appearance of the eviscerated bowel, and known time of exposure to amniotic fluid (gestational age at birth to gestational age at diagnosis). Neither the time of exposure to amniotic fluid (median duration of 14 weeks) nor the defect size could be correlated with eventual clinical outcome. The presence of small bowel dilatation and mural thickening on prenatal sonography (four patients) had a high correlation with severe intestinal damage and poor clinical outcome. The absence of these two sonographic findings (seven patients) was associated with mild intestinal changes and benign clinical course with no morbidity or mortality. We conclude that obstetric ultrasound cannot only accurately detect the presence and type of abdominal wall defect, but it also gives an indication of the severity of intestinal damage and subsequent clinical course in prenatally diagnosed cases of gastroschisis. Early delivery of the fetus with prenatally diagnosed gastroschisis should no longer be performed to limit exposure to amniotic fluid. Now that reliable sonographic criteria of severe intestinal damage have been defined, the decision to deliver early can be restricted to those fetuses with bowel dilatation and mural thickening.