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Study of Correlation between Fetal Bowel Dilation and Congenital Gastrointestinal Malformation
Yi Jiang1,2, Weipeng Wang1, Weihua Pan1
1Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd., Shanghai 200092, China.
Insights
Fetal bowel dilatation detected by ultrasound, especially the double-bubble sign, strongly suggests gastrointestinal malformations. Increased bowel diameter (over 18.05 mm) and diameter-to-gestational age ratio (over 0.4931) heighten this risk.
Area of Science:
- Medical Imaging
- Fetal Medicine
- Gastroenterology
Background:
- Ultrasound is key for detecting fetal bowel dilatation.
- The link between fetal bowel dilatation and gastrointestinal malformations requires further investigation.
- This study analyzes fetuses with bowel dilation to clarify this relationship.
Purpose of the Study:
- To investigate the correlation between fetal bowel dilatation and gastrointestinal malformations.
- To analyze the diagnostic value of bowel diameter and its ratio to gestational age in predicting malformations.
Main Methods:
- Retrospective analysis of 113 fetuses with bowel dilatation (July 2014-December 2019).
- Evaluation of the location and degree of bowel dilatation.
- Construction of ROC curves using bowel diameter and diameter-to-gestational age (D/GA) ratio.
Main Results:
- 97.6% of fetuses with upper GI dilatation (double-bubble sign) had malformations.
- 63.9% of fetuses with lower GI dilatation had malformations.
- The D/GA ratio (AUC 0.906, cutoff 0.4931) was more predictive than diameter alone (AUC 0.854, cutoff 18.05 mm) for lower GI dilatation.
Conclusions:
- The double-bubble sign strongly indicates duodenal obstruction.
- Bowel diameter >18.05 mm increases gastrointestinal malformation risk.
- A D/GA ratio >0.4931 is a significant indicator of increased risk for fetal gastrointestinal malformations.
Background:
Ultrasound serves as a valuable tool for the early detection of fetal bowel dilatation, yet the correlation between fetal bowel dilatation and gastrointestinal malformations remains to be further investigated. This study aims to explore the relationship by conducting a follow-up and analysis of fetuses with bowel dilation.
Methods:
A retrospective analysis was conducted on 113 fetuses with bowel dilatation at our center from July 2014 to December 2019. The location and degree of bowel dilatation were analyzed. ROC curves were constructed based on the diameter of the bowel and its ratio to fetal gestational age.
Results:
In total, 40 of 41 cases (97.6%) with upper gastrointestinal dilatation (double-bubble sign) and 46 of 72 cases (63.9%) with lower gastrointestinal dilatation were diagnosed with gastrointestinal malformations postnatally. The AUC of the dilatation diameter was 0.854 with a cutoff value of 18.05 mm in patients with lower gastrointestinal dilatation. The ratio of the diameter to gestational age (D/GA) showed a higher AUC of 0.906 with a cutoff value of 0.4931.
Conclusions:
The presence of the double-bubble sign in fetuses indicates a close association with duodenal obstruction. The risk of gastrointestinal malformations increases when the bowel diameter exceeds 18.05 mm, particularly when the D/GA surpasses 0.4931.
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