Postnatal Outcome of Fetuses With the Prenatal Diagnosis of Gastroschisis

Abstract

Objective. To assess the postnatal outcome and complications that arise in infants with the prenatal diagnosis of gastroschisis. Methods. Prenatal sonograms with the diagnosis of gastroschisis were identified. Maternal age, indication for sonography, gestational age at diagnosis, other sonographic abnormalities, and postnatal outcome were recorded. Results. Twenty-six fetuses at 16 to 36 weeks' gestational age had gastroschisis diagnosed on sonography. In 5 cases, other fetal anomalies were identified, including hydronephrosis and asymmetric hydrocephalus. In 9 of 21 cases followed by serial prenatal sonography, bowel dilatation developed, prompting delivery in 2. Two of the 26 study fetuses were electively terminated. The remaining 24 were born live and had immediate repair of the gastroschisis after birth. Nineteen infants (79%) had postnatal complications, some with multisystem complications, including 3 deaths, 10 with gastrointestinal complications, 6 with infectious complications, and 6 with anomalies involving other systems (genitourinary, cardiac, central nervous system, and respiratory). Only 5 infants (21%) had completely uncomplicated postsurgical courses. Hospital stays for survivors ranged from 10 to 98 days (mean, 38 days; median, 33 days). Conclusions. Although reported survival rates are good for gastroschisis, the postoperative hospital stay is often lengthy, and complications are very common, especially those related to the gastrointestinal tract. Other anomalies are uncommon but not rare.

Gastroschisis in the United States 1988–2003: analysis and risk categorization of 4344 patients

“…10,15 -17,20,21 Interestingly, our overall rate of intestinal atresia (n ¼ 265, 6.1%) is lower than the greater than 10% prevalence that is typically reported. 20,22,23 By combining two large national databases of hospital discharges, this study is the largest national study to date to profile the demographics of infants with gastroschisis. Additionally, we have also validated the categorization of these patients into simple and complex subgroups which differ in their use of hospital resources and subsequent survival.…”

Left Sided Gastroschisis With Limb Abnormalities

“…It is more common in younger mothers. The incidence is 10 -20 folds higher in women younger than 20 years than in women aged 25 to 29 years (3) . Other causes may be maternal use of vasoconstrictive drugs (ephedrine, pseudoephedrine or cocaine) and smoking (1) .…”

“…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) .…”

“…Unlike omphalocele, gastroschisis is not associated with chromosome abnormalities, so the survival rate is excellent (85% to 97%). Volvulus (rotation of the bowel) resulting in a compromised blood supply may, however, kill large regions of the intestine and lead to fetal death (1,3) . Gastroschisis associated with herniation of major viscus makes the prognosis worst.…”

“…Incidence of gastroschisis is 1:10,000 births (1,2) . It typically presents to the right of the umbilicus, although the defect may occasionally be to the left of the umbilicus (3) .…”