Ultrasound Markers for Complex Gastroschisis: A Systematic Review and Meta-Analysis

Abstract

Although gastroschisis is often diagnosed by prenatal ultrasound, there is still a gap in the literature about which prenatal ultrasound markers can predict complex gastroschisis. This systematic review and meta-analysis aimed to investigate the ultrasound markers that characterize complex gastroschisis. A systematic review of the literature was conducted according to the guidelines of PRISMA. The protocol was registered (PROSPERO ID CRD42020211685). Meta-analysis was displayed graphically on Forest plots, which estimate prevalence rates and risk ratios, with 95% confidence intervals, using STATA version 15.0. The combined prevalence of intestinal complications in fetuses with complex gastroschisis was 27.0%, with a higher prevalence of atresia (about 48%), followed by necrosis (about 25%). The prevalence of deaths in newborns with complex gastroschisis was 15.0%. The predictive ultrasound markers for complex gastroschisis were intraabdominal bowel dilatation (IABD) (RR 3.01, 95% CI 2.22 to 4.07; I2 = 15.7%), extra-abdominal bowel dilatation (EABD) (RR 1.55, 95% CI 1.01 to 2.39; I2 = 77.1%), and polyhydramnios (RR 3.81, 95% CI 2.09 to 6.95; I2 = 0.0%). This review identified that IABD, EABD, and polyhydramnios were considered predictive ultrasound markers for complex gastroschisis. However, evidence regarding gestational age at the time of diagnosis is needed.

Perinatal Outcomes of Neonates with Complex and Simple Gastroschisis after Planned Preterm Delivery—A Single-Centre Retrospective Cohort Study

“…It should be noted that the diagnosis of atresia is sometimes possible only in the postoperative period, hence the differences in frequency reported in the literature. In our group, 13 infants were diagnosed with cGS (21.3%) during surgery or in the postoperative period, whereas sGS was diagnosed in 48 infants (78.7%), which is consistent with the literature data [ 7 , 30 , 32 , 33 , 34 , 35 ].…”

“…Molik et al proposed dividing infants born with gastroschisis into a simple and complex type of the defect, as they were able to show that the two groups significantly differed in clinical presentation, postoperative complication rates, increased morbidity, length of hospital stay, and mortality [ 8 ]. The prevalence of cGS ranges from 11 to 33, mainly depending on the diagnosis of atresia, which is the most common complication in this group [ 8 , 22 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. It should be noted that the diagnosis of atresia is sometimes possible only in the postoperative period, hence the differences in frequency reported in the literature.…”

Improved Mortality of Patients with Gastroschisis: A Historical Literature Review of Advances in Surgery and Critical Care from 1960–2020

“…A multi-disciplinary approach to prenatal counseling, risk stratification, and management of complex cases is vital in this consideration [ 32 , 33 ]. Though potential predictive factors of complex gastroschisis have been identified with the use of prenatal imaging, refinement of prenatal evaluation of complex gastroschisis is still needed [ 32 , 37 ]. Furthermore, fetal surgery has also been more recently proposed, though further data and investigation is needed regarding this innovative intervention [ 38 , 39 ].…”

Additional Anomalies in Children with Gastroschisis and Omphalocele: A Retrospective Cohort Study

“…Although gastroschisis can be diagnosed on prenatal ultrasound from 12 weeks gestation, antenatal and postnatal differentiation between simple and complex gastroschisis remains challenging [ 11 ]. Several studies aimed to determine antenatal risk factors that could indicate whether atresia was present, but these risk factors remain inconclusive [ 12 ]. Patient-specific risk factors were never examined and may aid in predicting the presence of complex gastroschisis.…”