Outcome of antenatally diagnosed abdominal wall defects (original) (raw)

Advances in prenatal and perinatal diagnosis and management of gastroschisis

Seminars in Pediatric Surgery, 2018

Gastroschisis is a congenital, ventral wall defect associated with bowel evisceration. The defect is usually to the right of the umbilical cord insertion and requires postnatal surgical correction. The fetus is at risk for complications such as intrauterine growth restriction, preterm delivery, and intrauterine fetal demise. In addition, complex cases, defined by the presence of intestinal complications such as bowel atresia, stenosis, perforation, or ischemia, occur in up to one third of pregnancies affected by gastroschisis. As complex gastroschisis is associated with increased morbidity and mortality, research has focused on the prenatal detection of this high risk subset of cases. The purpose of this review is to discuss the prenatal, diagnostic approach to the identification of gastroschisis, to describe potential signs of complex gastroschisis on prenatal ultrasound, to review current guidelines for antepartum management and delivery planning, and to summarize results of both past and current intervention trials in fetuses with gastroschisis.

Characteristics and perinatal course of prenatally diagnosed fetal abdominal wall defects managed in a tertiary center in Japan

Journal of Obstetrics and Gynaecology Research, 2009

To identify the clinical characteristics of fetal abdominal wall defects managed at a single institution and to provide information regarding the most likely clinical course of the affected fetuses. Methods: A retrospective review was conducted of 44 fetuses prenatally diagnosed with abdominal wall defects at Kyushu University Hospital between 1990 and 2006. Results: A total of 11 cases of gastroschisis and 33 cases of omphalocele were found. Preterm delivery was observed in eight of 11 fetuses (72.7%) with gastroschisis and in 14 of 27 fetuses (51.9%) with omphalocele who were not artificially aborted. Intrauterine growth restriction (IUGR) was identified in four of 11 fetuses (36.4%) with gastroschisis and in 13 of 27 fetuses (48.1%) with omphalocele who were not aborted artificially. There was a high rate of associated structural anomalies with omphalocele (26/33). Karyotypic abnormalities were observed in eight of 29 tested fetuses with omphalocele (27.6%). The prognosis for a chromosomally normal fetus with omphalocele appeared to largely depend on the associated structural abnormalities and the gestational age at delivery. Despite the frequent presence of IUGR, the outcome of neonates with gastroschisis was good.

Gastroschisis: Prenatal Diagnosis and Outcome

Congenital Anomalies - From the Embryo to the Neonate, 2018

The purpose of this retrospective cohort study was to investigate and identify prenatal predictors of perinatal outcomes of gastroschisis. Antenatal data included extra-abdominal bowel dilatation (EABD) and intra-abdominal bowel dilatation (IABD). Perinatal data included gestational age, sex, and birth weight. Surgical data included presence of intestinal atresia, necrosis, perforation, strictures, and method of closure. Outcome data included duration of mechanical ventilation and total parenteral nutrition, pseudoobstruction, sepsis, reoperations, length of hospital stay, and mortality rates. Results were analyzed in 65 patients. EABD was documented in 55 patients with no significant difference between simple and complex gastroschisis group. In 27 patients (in 32% of simple and 73% of complex cases), IABD persisted until the last ultrasound scan. Simple gastroschisis group had a shorter hospital stay, shorter ventilation support duration, less bowel pseudoobstruction, less need for reoperation, and received less parenteral nutrition. The most frequent extraintestinal complication was sepsis. The only factor that has been shown to predict poorer outcomes of gastroschisis is the presence of complex gastroschisis. Current available evidence suggests that antenatal bowel dilatation is not associated with increased risk of adverse perinatal outcome in infants with gastroschisis. Also, the absence of bowel dilatation cannot fully exclude complex patients.

Non-viable Neonatal Gastroschisis: Case Report

Gastroschisis is one of the major congenital defects of the abdominal wall, the incidence reported worldwide is one per 20,000 births, in a defect that is frequently located at the para-umbilical level to the right of the umbilical insertion, with a usual size of 2-4 cm, through which mainly protrudes small and large intestine, without being covered by avascular and translucent amniotic peritoneum membrane, that is due to the premature interruption on the irrigation of the right omphalomesenteric artery. This entity requires postnatal surgical repair by primary closure of the fascia or secondary closure as soon after birth, the survival rate for gastroschisis has revealed that lower and middle-income countries have lower survival in gastroschisis. This article is about the case of a Gastroschisis baby, female newborn of 38 gestational weeks, attended at Hospital General del Sur, Choluteca, Honduras, whose mother had poor prenatal control, not performed by a physician, without obstetric ultrasound during pregnancy. At physical examination presents multiple congenital malformations, increased of cephalic perimeter suspicion of hydrocephalus, hypertelorism, cleft lip, cleft palate, and gastroschisis with evisceration of liver, small intestine, large intestine, right superior pole of the right kidney, equino varus, who was a non-viable neonatal gastroschisis. Public health and prenatal interventions should target atrisk populations to improve clinical outcomes. An prenatal control is essential in the early detection of Gastroschisis and congenital malformations, emphasizing in factors associated with an increased risk for gastroschisis, helping clinical outcomes by starting the management earlier, the decision about management often occurs before birth.

Perinatal management of gastroschisis

Journal of Pediatric and Neonatal Individualized Medicine, 2014

Gastroschisis is an abdominal wall defect, typically located to the right of the umbilical cord, requiring an early surgical treatment shortly after birth. Affected patients can be identified during intrauterine life with US and should be delivered in referral hospitals where a multisciplinary approach can be provided, involving neonatologists, clinical geneticists, surgeons and other specialists. These patients require a complex management in Neonatal Intensive Care Unit (NICU) and a long term follow-up after discharge. Exceed the acute neonatal condition, gastroschisis has a good prognosis, if there are no overlapping complications, and it should be differentiated from omphalocele, burdened with worse prognosis, and other conditions in the wide spectrum of abdominal wall defects.

The effect of gestational age at birth on morbidity in patients with gastroschisis

Journal of Pediatric Surgery, 1996

• Infants born with gastroschisis frequently present with an eviscerated intestinal segment that is inflamed and thickened. The damaged segment of intestine displays absorption and motility disturbances for a variable period of time after gastroschisis repair. Clinical and animal research suggests that the damage to the eviscerated intestine is caused by prolonged exposure to amniotic fluid and/or progressive constriction on the intestine and its blood supply by the umbilical ring. Some obstetricians and pediatric surgeons have advocated early elective delivery to decrease the exposure of the bowel to these potentially damaging influences. Fifty-five patients underwent gastroschisis repair at the authors' institution during the last 6 years. Many of these patients had early elective delivery after their pulmonary maturity was judged adequate based on their amniotic lecithin/sphingomyelin ratios, The patients were divided into three groups according to gestational age at the time of delivery. Elective early delivery did not lessen the need for silo closure or hasten the time until enteral feeding could be tolerated. The hospital stay was not shortened for the early delivery group. This retrospective review supports the concept that patients with sonographicaliy identified antenatal gastroschisis are best managed by delivery at full term.

Perinatal Management of Gastroschisis: Analysis of a Newly Established Clinical Pathway

Journal of pediatric …, 2005

The authors developed a clinical pathway for optimal management after antenatal diagnosis of gastroschisis. This is the outcomes analysis of our first 30 consecutive patients. Method: Antenatal counseling was provided for all families with in-utero diagnosis of gastroschisis. Bowel dilatation, thickness, motility, amniotic fluid volume, and fetal development were followed by ultrasonography every 4 weeks. Babies were delivered by cesarean section between 36 and 38 weeks gestation if the lungs were mature or earlier for bowel complications. Gastroschisis repair was scheduled 90 minutes after birth. Primary repair was attempted in all through the abdominal wall defect without an additional incision, resulting in an umbilicus with no abdominal scar. Results: Primary repair was achieved in 83%. Babies needed assisted ventilation for 3 days, reached full feeds by 19 days, and were discharged by 24 days (all medians). There were 3 (10%) deaths, all after staged repair. Conclusions: Our new protocol of both scheduled elective cesarean section and early gastroschisis repair resulted in a higher proportion of primary repair, shorter duration of mechanical ventilation, earlier full feeds, and shorter length of stay. There was no increase in mortality or morbidity. The primary-repair babies had no mortality and had excellent cosmesis.

Management of the fetus with an abdominal wall defect

Journal of Pediatric Surgery, 1984

Eleven fetuses with omphalocele and two with gastroschisis were diagnosed by prenatal ultrasonographic examination. Intact omphalocele was accurately distinguished from gastroschisis by detection of a membranous sac covering the herniated viscera, by liver protruding from the abdomen, and by the frequent association of major structural anomalies. Gastroschisis was characterized by the absence of these findings and the presence of bowel loops floating freely in the amniotic fluid. Nine of eleven fetuses with omphaloceles had other major malformations and did not survive. Two small omphaloceles and two gastroschises were correctly diagnosed as isolated defects, free from associated anomalies. All four underwent maternal transport and were successfully managed with good outcome. Prenatal ultrasonography allows rational decisions about perinatal management by distinguishing between omphalocele and gastroschisis and by screening for associated anatomic defects. Karyotype analysis should be a part of the prenatal workup. Most isolated defects can be followed and delivered normally near term. Accurate prenatal diagnosis allows maternal transport and in a few cases may alter the timing or mode of delivery.