Gastroschisis: Antenatal Sonographic Predictors of Adverse Neonatal Outcome

Abstract

Objectives. The aim of this review was to identify clinically significant ultrasound predictors of adverse neonatal outcome in fetal gastroschisis. Methods. A quasi-systematic review was conducted in PubMed and Ovid using the key terms “gastroschisis,” “predictors,” “outcome,” and “ultrasound.” Results. A total of 18 papers were included. The most common sonographic predictors were intra-abdominal bowel dilatation (IABD), intrauterine growth restriction (IUGR), and bowel dilatation not otherwise specified (NOS). Three ultrasound markers were consistently found to be statistically insignificant with respect to predicting adverse outcome including abdominal circumference, stomach herniation and dilatation, and extra-abdominal bowel dilatation (EABD). Conclusions. Gastroschisis is associated with several comorbidities, yet there is much discrepancy in the literature regarding which specific ultrasound markers best predict adverse neonatal outcomes. Future research should include prospective trials with larger sample sizes and use well-defined and consistent definitions of the adverse outcomes investigated with consideration given to IABD.

Gastroschisis. Case report and management in primary care services

“…(16-18) The final outcome is the eventration of abdominal contents in utero that, regardless of the size and quantity of viscera exposed, is associated with a mortality of 5% and 3-15% after birth. (5,7,8,12) However, these deaths may be associated with complications and significant morbidity, prolonged hospital stays, need for mechanical ventilation, prolonged parenteral nutrition, multiple surgical interventions and diseases such as intestinal atresia, short bowel syndrome, neonatal sepsis and necrotising enterocolitis. (7)(8)(9)12) DIAGNOSIS A gastroschisis diagnosis can be achieved in the prenatal stage by means of an ultrasonography, which has high sensitivity and specificity for its detection.…”

“…(5,7,8,12) However, these deaths may be associated with complications and significant morbidity, prolonged hospital stays, need for mechanical ventilation, prolonged parenteral nutrition, multiple surgical interventions and diseases such as intestinal atresia, short bowel syndrome, neonatal sepsis and necrotising enterocolitis. (7)(8)(9)12) DIAGNOSIS A gastroschisis diagnosis can be achieved in the prenatal stage by means of an ultrasonography, which has high sensitivity and specificity for its detection. Detecting the disease is possible since week 12 (19) with rates of up to 90%, depending on the quality of the equipment used, the institution were the examination is performed and the experience of the staff (19)(20)(21)(22), which would explain why, in this case, the pathology was not detected prenatally, despite the adequate number of controls and two ultrasound scans taken after week 12.…”

“…(7,23) Some predictors are intra-abdominal dilation of the bowel (7,8), intrauterine growth restriction (8), thickness of the abdominal wall (8) and liver herniation. (8) …”

“…(1,3) As they are not covered by membranes, the eviscerated structures are exposed to amniotic fluid and external substances after birth, which increases the risk of infection and injuries. (1,3,4) This is a low-prevalence disease (5-7) of great importance due to the excellent prognosis and survival of patients (8)(9)(10) when providing adequate management. (11,12) …”

Prenatal Diagnosis of Gastroschisis at an Imaging Facility in Ghana

“…The abnormality is mostly located to the right of the umbilical ring [1,2] and believe to be caused by disruptions in the blood supply to a developing abdominal wall from the omphalomesenteric duct artery at about eighth week of gestation [3]. It is not specifically known what causes the blood supply disruption, but few factors have been associated.…”