354 Sonographic bowel findings among fetuses with gastroschisis do not predict antenatal and delivery outcomes

Abstract

Among fetuses with gastroschisis, data are conflicting regarding antenatal sonographic bowel findings and postnatal outcomes. At our institution, we perform weekly ultrasounds at 32 weeks for all gastroschisis pregnancies. Our study examined the association of sonographic bowel measurements in fetal gastroschisis with antenatal and delivery outcomes. A single-institution, retrospective cohort study of 116 pregnancies complicated by gastroschisis delivered between 2011 and 2020. We reviewed ultrasounds documenting fetal bowel measurements including intra- and extra-abdominal bowel dilation, internal and external bowel wall thickness, and stomach cross-section. To evaluate the association of these measurements with antepartum and delivery outcomes, we ran logistic and linear models using generalized estimating equations to account for clustering across patients. Mean gestational age (GA) at delivery was 36.4 weeks with mean birthweight 2537g. 43% were delivered by Cesarean, with 73% undergoing induction of labor. Mean GA of NST start was 31.2 weeks, and 32% of patients had an NST abnormality that led to delivery. Several perinatal outcomes reached statistical significance, however with negligible clinical impact. Intra-abdominal bowel dilation was associated with 0.05 week decrease in delivery GA (95% CI -0.07, -0.03). Intra-abdominal bowel wall thickness was associated with a 0.22 week increase in GA of NST start (95% CI 0.07, 0.37), 0.08 week difference in GA at delivery (95% CI 0.02, 0.15), 0.26 increase in umbilical artery base deficit (95% CI 0.09, 0.43), and OR 0.83 (95% CI 0.7, 0.99) of Cesarean delivery. Extra-abdominal bowel dilation was not associated with any evaluated outcome. Extra-abdominal bowel wall thickness was associated with 0.1 increase in umbilical artery base deficit (95% CI 0.02, 0.19) and 0.05 increase in 5-min APGAR (95% CI 0.01, 0.09). In utero bowel findings for gastroschisis fetuses, while occasionally reaching statistical significance, were not associated with clinically significant differences in antenatal or delivery outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)