Outcome of prenatally diagnosed anterior abdominal wall defects

Abstract

One hundred consecutive cases of confirmed anterior abdominal wall defect, identified prenatally in the Oxford Prenatal Diagnosis Unit over 11 years, were studied. Fifty nine per cent of cases were suspected omphaloceles and 41% suspected gastroschisis. Fifty four per cent of omphaloceles were accompanied by other defects compared with 5% of those with gastroschisis. Overall, 29% of fetuses with omphalocele had an abnormal karyotype, and of those with another abnormality identified on scan (excluding four cases with no karyotype performed), 54% had an abnormal karyotype. Of the 27 cases with suspected isolated omphalocele, 14 were live born, all of whom have survived. If the 11 whose parents opted for termination of pregnancy are excluded, survival to birth was 88%. Six of the suspected isolated omphaloceles have Beckwith Wiedemann syndrome (BWS). Eight (57%) of the live born babies with omphaloceles had major problems up to the age of 2, but only one (7%) has long term major problems. This child has BWS and is deaf.Of the 39 cases of suspected isolated gastroschisis, 33 (85%) pregnancies resulted in live birth and one in neonatal death after surgery. Survival rate (excluding terminated pregnancies) was 97%. Gastroschisis was associated with a younger maternal age than omphalocele (p<0.001) and lower birthweight centile (p<0.01).Fifteen per cent of the gastroschisis babies had major problems up to the age of 2 years and 12% long term developmental problems. Ninety three per cent of the omphalocele babies and 88% of those who had gastroschisis have no long term problems. Over the study period there have been major changes in scanning equipment and expertise. Since 1991 no woman with a suspected isolated lesion has opted for termination of pregnancy. (Arch Dis Child Fetal Neonatal Ed 1998;78:F209-F213)

Omphalocele and gastroschisis: An 18-year review study

“…In an earlier study, 17 the mean maternal age was 20.4 years for gastroschisis, as compared to 28.0 years for the general population. Boyd et al 18 also found younger mothers in their gastroschisis group. Torfs et al 19 found the incidence of gastroschisis to be highest among mothers under 20 years old, with the incidence declining steeply with increasing maternal age; only 7% of mothers were over 29 years of age in their group.…”

Growth and neurodevelopment at 16 to 24 months of age for infants born with gastroschisis

“…8,11,12,23 Lunzer et al 11 conducted interviews of parents of 10 gastroschisis survivors at 3 to 12 years of age. Two reported a learning disability, and one reported mental retardation.…”

“…25 Developmental delay has been reported in 3 of 26 infants with gastroschisis as evaluated by parental questionnaire. 12 Comparing the results of previous studies to a contemporary cohort of infants with gastroschisis is problematic for several reasons. First, the outcome of cohorts that include all abdominal wall defects may be influenced by the comorbid conditions associated with different lesions.…”

“…[8][9][10][11] As a result, some studies report normal growth, and others report a high percentage of growth failure. [11][12][13] Neurodevelopmental findings also vary, with both impaired development 8 and normal development 12 reported. Advances over the past 15 years in neonatal care, including improved respiratory management and parenteral nutrition, may have improved long-term growth and neurodevelopment.…”

Left Sided Gastroschisis With Limb Abnormalities

“…The unusual associations of gastroschisis are limb-body wall defect syndrome (amniotic band syndrome), meningocoele, abnormal genitalia, umbilical cord abnormalities and gastrointestinal anomalies such as intestinal atresia, stenosis and malrotation (8,9) . In the literature, extra-intestinal anomalies are reported in 5% to 29% of infants with gastroschisis and include a variety of anomalies affecting the skeletal system, cardiovascular system and central nervous system (3,10,11) . In a study by Stoll C et al (2012) for associated malformations with gastroschisis, between 1979 and 2003 in 3,34,262 consecutive births, out of the 60 cases of gastroschisis, had associated malformations in 10 (16.6%) (9) .…”