Advances in prenatal and perinatal diagnosis and management of gastroschisis

Oakes, Megan C.; Porto, Manuel; Chung, Judith H.

doi:10.1053/j.sempedsurg.2018.08.006

Cited by 39 publications

(42 citation statements)

References 68 publications

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“…15 Characteristic ultrasound findings include a right-sided periumbilical abdominal wall defect with free floating intestinal loops (in the amniotic cavity) ( Figure 2); additional visceral (eg, liver or stomach) herniation may also be present depending on the diameter of the abdominal wall defect. 16 Upon diagnosis, prenatal fetal surveillance is initiated to evaluate fetal weight, bowel diameter and AF index for disease prognostication, an essential component of parental counseling and perinatal management. 17 Fetal growth restriction occurs in up to 60% of gastroschisis cases and is associated with small for gestational age and poor prognosis.…”

Section: Rationale For Fetal Intervention For Gastroschisismentioning

confidence: 99%

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

et al. 2020

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We conducted a comprehensive evidence‐based review on the epidemiology and current standard of care of gastroschisis management as well as the pathophysiology, rationale and feasibility of fetal therapy as a viable alternative. Gastroschisis is a periumbilical abdominal wall defect characterized by abdominal viscera herniation in utero. It affects 4 in 10 000 live births, but the prevalence has steadily increased in recent years. Gastroschisis is typically diagnosed on routine second‐trimester ultrasound. The overall prognosis is favorable, but complex gastroschisis, which accounts for about 10% to 15% of cases, is associated with a higher mortality, significant disease burden and higher healthcare costs due to long‐ and short‐term complications. The current standard of care has yet to be established but generally involves continued fetal surveillance and multidisciplinary perinatal care. Postnatal surgical repair is achieved with primary closure, staged silo closure or sutureless repair. Experimental animal studies have demonstrated the feasibility of in utero closure, antiinflammatory therapy and prenatal regenerative therapy. However, reports of early preterm delivery and amnioinfusion trials have failed to show any benefit in humans. Further experimental studies and human trials are necessary to demonstrate the potential benefit of fetal therapy in gastroschisis.

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Section: Rationale For Fetal Intervention For Gastroschisismentioning

confidence: 99%

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

et al. 2020

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“…Prenatal detection or prediction of complex gastroschisis would lead to more complete parental counseling. The association between two‐dimensional (2D) prenatal ultrasound findings (eg, bowel dilatation, stomach dilatation, or amniotic fluid index) and complex gastroschisis has been investigated in a number of studies, which showed conflicting results . Intra‐abdominal bowel dilatation has been associated with intestinal atresia, but its positive predictive value is debatable .…”

Section: Introductionmentioning

confidence: 99%

Using three‐dimensional ultrasound in predicting complex gastroschisis: A longitudinal, prospective, multicenter cohort study

et al. 2019

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Objective To determine whether complex gastroschisis (ie, intestinal atresia, perforation, necrosis, or volvulus) can prenatally be distinguished from simple gastroschisis by fetal stomach volume and stomach‐bladder distance, using three‐dimensional (3D) ultrasound. Methods This multicenter prospective cohort study was conducted in the Netherlands between 2010 and 2015. Of seven university medical centers, we included the four centers that performed longitudinal 3D ultrasound measurements at a regular basis. We calculated stomach volumes (n = 223) using Sonography‐based Automated Volume Count. The shortest stomach‐bladder distance (n = 241) was determined using multiplanar visualization of the volume datasets. We used linear mixed modelling to evaluate the effect of gestational age and type of gastroschisis (simple or complex) on fetal stomach volume and stomach‐bladder distance. Results We included 79 affected fetuses. Sixty‐six (84%) had been assessed with 3D ultrasound at least once; 64 of these 66 were liveborn, nine (14%) had complex gastroschisis. With advancing gestational age, stomach volume significantly increased, and stomach‐bladder distance decreased (both P < .001). The developmental changes did not differ significantly between fetuses with simple and complex gastroschisis, neither for fetal stomach volume (P = .85), nor for stomach bladder distance (P = .78). Conclusion Fetal stomach volume and stomach‐bladder distance, measured during pregnancy using 3D ultrasonography, do not predict complex gastroschisis.

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“…Indications for caesarean delivery in gastroschisis‐complicated pregnancies should be the same as in uncomplicated pregnancies . Some indications for caesarean delivery, such as foetal heart rate abnormalities, are more common in foetuses with gastroschisis, and therefore, a higher rate of caesarean as a direct result of such obstetric complications among these pregnancies is expected.…”

mentioning

confidence: 99%

“…Advancements in ultrasonography increasingly allow for the detection of associated features, such as bowel dilation and wall thickness, which may assist in prenatal detection of cases of complex gastroschisis. Gastroschisis is considered complex if other intestinal complications are present and is associated with longer length of hospital stay, longer duration of parenteral feeding, and an increased risk of neonatal mortality . It is possible that specific ultrasound findings, which have been associated with complex gastroschisis, may also influence mode of delivery decision making, but the topic has not been studied.…”

mentioning

confidence: 99%

“…Furthermore, foetuses with gastroschisis are at an increased risk of intrauterine growth restriction and foetal demise. Consequently, this leads to increased antepartum surveillance through the use of serial growth ultrasounds and foetal heart rate testing . Results from this increased surveillance account for up to a third of expedited deliveries among gastroschisis‐affected pregnancies, of which nearly 90% are delivered by caesarean .…”

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Gastroschisis and mode of delivery: It’s complex

Parker

Yarrington

2019

Paediatric Perinatal Epid

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Commentary on: Lopez A, Benjamin RH, Raut JR, Ramakrishnan A, Mitchell LE, Tsao K, et al. Mode of delivery and mortality among neonates with gastroschisis: A population-based cohort. in Texas. Gastroschisis is an increasingly prevalent abdominal wall defect affecting approximately 5 per 10 000 births. 1 Controversy in the late 1980s regarding the safest mode of delivery for foetuses with a prenatal diagnosis of gastroschisis has since been replaced with a general consensus in the obstetric community that vaginal delivery can be attempted, barring other obstetric complications. The basis for this consensus comes from numerous studies showing no benefit of caesarean delivery on neonatal outcomes. 2 Despite this evidence base, rates of caesarean delivery for gastroschisis in the United States remain as high as 60%, leaving room for improvement. 3In this issue of Paediatric and Perinatal Epidemiology, Lopez et al 4 revisit this topic, specifically focusing on infant mortality as the outcome, using a large birth defect registry-based cohort of infants with gastroschisis. This study has many strengths including the use of a large, population-based sample that identified cases through medical record review, which has been shown to be a superior method of case ascertainment than birth certificates. 5 Data on potential confounders were also collected and included in adjusted models which represents an improvement over many of the previously published studies on this topic. The results from their analysis, in addition to their update of a meta-analysis, demonstrate no association between mode of delivery and mortality among infants with gastroschisis. While these data are important in contributing to the evidence that supports attempted vaginal delivery, they offer no actionable approaches to reducing the rate of caesarean delivery among these pregnancies. After numerous studies of mode of delivery and mortality, it is now time to understand what drives mode of delivery decision making among pregnancies affected by gastroschisis to identify opportunities to reduce the rate of caesarean among this very specific population. Indications for caesarean delivery in gastroschisis-complicatedpregnancies should be the same as in uncomplicated pregnancies. 6 Some indications for caesarean delivery, such as foetal heart rate abnormalities, are more common in foetuses with gastroschisis, and therefore, a higher rate of caesarean as a direct result of such obstetric complications among these pregnancies is expected. It follows, then, that in order to reduce the caesarean rate, other factors that influence obstetric decision making need to be elucidated. While there is evidence that attempted vaginal delivery among otherwise uncomplicated pregnancies affected by gastroschisis is increasing, planned caesareans still account for a third of these deliveries, 7 representing a group that may be targeted for caesarean rate reduction.Guidance around results of antepartum surveillance among foetuses with gastroschisis as it relates to mode of d...

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Advances in prenatal and perinatal diagnosis and management of gastroschisis

Cited by 39 publications

References 68 publications

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

Using three‐dimensional ultrasound in predicting complex gastroschisis: A longitudinal, prospective, multicenter cohort study

Gastroschisis and mode of delivery: It’s complex

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