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Gastroschisis: can antenatal ultrasound predict infant outcomes?
P G Pryde1, M Bardicef, M C Treadwell
1Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University, Detroit, Michigan.
Objective:
To test previously proposed but unproven antenatal ultrasound prognostic criteria in fetal gastroschisis.
Methods:
Thirty consecutive gastroschisis-affected pregnancies and their outcomes were reviewed retrospectively. Data were tabulated by review of antenatal ultrasound videotapes, with blinded comparison to indicators of short- and long-term infant outcomes obtained from the medical records. Criteria of previous reports were applied to these data, focusing on their ability to prognosticate effectively.
Results:
Applying a criterion of 10 mm bowel dilatation proved minimally useful in prognosticating infant outcomes. However, a stricter 17-mm criterion for clinically important bowel dilatation provided prognostic information, with remarkable improvement in specificity (75 versus 37%) and positive predictive value (55 versus 37%) for infant morbidity, with comparatively little loss of sensitivity (71 versus 85%).
Conclusions:
Bowel dilated more than 17 mm on antenatal ultrasound appears to be associated with increased short- and long-term infant morbidity. Whether this finding warrants obstetric intervention in the preterm gastroschisis-affected pregnancy with substantial bowel dilatation remains to be determined.