A Decade of Gastroschisis in the Era of Antenatal Ultrasound

Abstract

Background: Gastroschisis is an uncommon condition in which viscera protrude at the base of the umbilical cord. To investigate the possible relationships between antenatal ultrasound findings, patient demographics, smoking, alcohol consumption and this condition, 21 causes are reviewed. Methods: The medical records and antenatal ultrasounds of 21 children diagnosed with gastroschisis at the Adelaide Children's Hospital between 1 January 1985 and 31 December 1992 were reviewed. Results: Antenatal ultrasound was employed in 15 cases, and the diagnosis was accurately made in 13 (86.7%) of these. There were 17 live births, two elective terminations and two pre‐term abortions. Seven of the 21 cases had associated anomalies. The anomalies included five atresias, a ventricular septal defect (VSD), and a dislocated gall‐bladder. Postoperative complications (which included one death) occurred in seven of the 17 patients. Bowel dilatation or thickening was first detected on five ultrasound examinations performed before 21 weeks' gestation, and four ultrasounds after 21 weeks. The nine cases with bowel changes on ultrasound were associated with a high atresia rate and a longer hospital stay, but not with an increased complication rate. Maternal race, parity, and alcohol consumption were not associated with increased risk of fetal gastroschisis. All mothers were under 27 years of age. There were nine mothers who smoked during pregnancy and a disproportionate number of mothers who lived outside the metropolitan area with gastroschisis‐affected offspring. Conclusions: Bowel changes seen on antenatal ultrasound increase the chances of intestinal atresia and longer hospitalization. Smoking during pregnancy may be associated with an increased risk of gastroschisis.

Influence of Antenatal Ultrasound on the Management of Fetal Exomphalos

“…The higher incidence of exomphalos in mothers outside the metropolitan area correlates with a similar but more marked finding from our institution for gastroschisis [24]. Country areas in South Australia accounted for just 13% of the total population but were the place of gestation for 26% of the fetuses with exomphalos.…”

“…The relatively older age of mothers of fetuses with exomphalos compared with gastroschisis found in this study is well recognized and contrasts with more recent data which suggests a particularly high incidence of the latter in teenage mothers [18,23,24]. Our study illustrates the difficulties of a retrospective review in that we were unable to obtain accurate data on tobacco and ethanol consumption, although neither has been previously linked to exomphalos [18].…”

Antenatal diagnosis of bowel dilatation in gastroschisis is predictive of poor postnatal outcome

“…Comparison between studies is problematic because of differing thresholds for bowel dilatation. A range of values from more than 10 mm [12,15,16] to more than 20 mm [29] have been used, with some studies not giving a value at all [19,21,22]. The finding of dilatation is both operator and technology dependent, and the resolution of antenatal ultrasound machines has significantly improved in the last two decades [30].…”

“…The results have been varied and inconsistent [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Consequently, there is still a degree of uncertainty as to whether antenatal sonographic variables are useful in prognostification.…”

Silo pouch stoma: a rescue procedure for intestinal catastrophe in gastroschisis

“…Still, considerable controversy exists in several areas of gastroschisis management, including the optimal timing, location, and mode of delivery of the infant. Intestinal atresia is estimated to occur in approximately 10% to 20% of infants with gastroschisis [3][4][5] and has been considered to be a significant contributor to morbidity and mortality [6].…”