Is Preterm Delivery Indicated in Fetuses with Gastroschisis and Antenatally Detected Bowel Dilation?

Abstract

Introduction: Due to the controversy surrounding diagnostic ultrasound evaluations and elective preterm delivery of fetuses with gastroschisis, we sought to calculate the predictive value of bowel dilation in fetuses with gastroschisis and evaluate the effect of preterm delivery on neonatal outcomes. Materials and Methods: Ultrasounds and medical records of 103 mother-infant pairs with fetal gastroschisis were reviewed. Eighty-nine pairs met the criteria. Intestinal complications, gestational age at delivery, birth weight, and number of abdominal surgeries were documented. Results: Forty-eight fetuses (54%) had bowel dilation and 41 (46%) did not. The positive predictive value of bowel dilation for complicated gastroschisis was 21%. There were 50 (56%) preterm and 39 (44%) term deliveries. The mean birth weight was 2,114 g (SD = 507) and 2,659 g (SD = 687), p = 0.001. For infants delivered preterm, the mean number of postnatal abdominal surgeries was 2.1 (SD = 1.1) as compared to 1.3 (SD = 0.5) surgical procedures for those infants delivered at term gestation. This was not statistically significant. With respect to hospital stay for each group, the mean length of neonatal intensive care unit admission was 48 days (SD = 33) in the preterm group and 35 days (SD = 50) in the term group, which was not statistically significant. Discussion: Ultrasound-detected bowel dilation was not predictive of important intestinal complications. Our data did not substantiate any benefit for elective preterm delivery of neonates with gastroschisis.

National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey

“…The types of testing performed were also consistent with the recommendations in the literature, although the significance of each test remains controversial. The NST (55%; 72/129) and BPP (50%; 63/126) were two of the more consistently utilized surveillance tests in our study, similar to a number of studies reported in the literature [7, 24-26]. While ultrasound for EFW was performed weekly by the majority of providers (79%; 104/131), at least two other studies disagreed on its ability to accurately predict adverse outcomes [27, 28].…”

Predicting Perinatal Outcome from Prenatal Ultrasound Characteristics in Pregnancies Complicated by Gastroschisis

“…The predictive value for adverse perinatal outcome of different thresholds of bowel dilatation at the last prenatal ultrasound has been previously studied [16,26,27,28,29,30,31,32,33,34,35]. Controversially, Page et al [36] in a recent systematic review concluded that IABD seen on an antenatal ultrasound scan is not a finding associated with an increased risk of adverse perinatal outcome.…”

“…We demonstrated, as other groups [29,32], that IABD is a strong ultrasound predictor of complex GS. Adjusting for gestational age improved the predictive accuracy of this indicator compared to fixed threshold models [34,35]. Interestingly, in 2 cases, IABD seen during the second trimester regressed spontaneously, advocating for caution when interpreting this ultrasound finding early in pregnancy.…”

Identifying strategies to decrease infectious complications of gastroschisis repair

“…Gastroschisis patients are often delivered preterm, either electively owing to preterm labor or owing to complications of pregnancy. Various outcomes have been reported in the literature related to this topic, and the results have been mixed [1,2,7,10,[12][13][14][15]. There are some reports of worse outcomes with early delivery, including an increased risk of infectious complications and poorer long-term neurodevelopmental outcomes [8,12].…”