Omphalocele Management using Goal-oriented Classification in African Centre with Limited Resources

Abstract

In 2000-09, 96 children comprising 57 males and 39 females who were presented between 2 h and 1 week of birth with omphalocele were prospectively managed using goal-oriented classification at the University of Benin Teaching Hospital, Nigeria. All were born through spontaneous vaginal delivery, out of which 9 (9.4%) were preterm. Eighty-two (85.4%) mothers in villages with no supervised antenatal care/delivery and/or prenatal diagnosis presented their babies late. Thirty-three (34.4%) babies in group A, with defect size ≤ 4.5 cm and intact sac, were managed conservatively and had fascial closure after neonatal period, resulting in 32 (97%) survivors. Forty-two (43.8%) babies in group B, with defect size > 4.5 cm and intact sac, were managed conservatively and had fascial closures for 9 months to 5 years, resulting in 40 (95.2%) survivors. Group C comprised of 21 (21.9%) babies with defect of any size/ruptured sac and who had immediate repair, resulting in two (9.5%) survivors owing to lack of facilities (p < 0.0001). Hospital delivery and provision of facilities are advocated.

Choice of topical substances in the conservative management of Exomphalos – A systematic review

“…Initial search resulted in 1243 studies; after excluding duplicates and non‐eligible studies, 42 studies were deemed suitable and offered 822 patients for analysis 3–45 . Gestational age was reported in 16 studies with a median of 36 (29–39) weeks.…”

Onfalocele gigante. Presentación de un caso en sesión anatomopatológica y consideraciones generales

“…2,3 No existen datos exactos sobre la incidencia de onfalocele en México; sin embargo, existen reportes de que el onfalocele es más frecuente en poblaciones pobres y remotas, analfabetas y con acceso limitado al adecuado manejo perinatal. 4,5 La falta de diagnóstico prenatal y de referencia oportuna a un tercer nivel de atención, así como un traslado inadecuado, están asociados con mal pronóstico. 4,5 La sensibilidad para el diagnóstico del onfalocele por ultrasonido es de 75% y puede ser detectado a partir de las 18 semanas de gestación.…”

“…4,5 La falta de diagnóstico prenatal y de referencia oportuna a un tercer nivel de atención, así como un traslado inadecuado, están asociados con mal pronóstico. 4,5 La sensibilidad para el diagnóstico del onfalocele por ultrasonido es de 75% y puede ser detectado a partir de las 18 semanas de gestación. Las características ultrasonográficas para establecer el diagnóstico son: la posición del defecto en relación con el cordón umbilical, el tamaño del defecto, los órganos eviscerados y la presencia de membranas.…”

Silver sulfadiazine as the topical treatment for giant omphalocele: a case report

“…Omphalocele occurs due to failure of the four embryonic folds to meet in the midline and form an umbilical ring before the 10 th week of gestation, resulting in ventral abdominal wall defect of varying degrees. 2 The optimal route of delivery is still controversially discussed. The clinicians should consider the defect size, herniated organs in the sac, the integrity of the sac and any other associated abnormalities.…”