Current practice for gastroschisis prenatal surveillance among society for maternal fetal medicine (SMFM) members

Abstract

BackgroundGastroschisis is an abdominal wall defect with potential devastating outcomes, including short bowel syndrome (SBS). The objective of this study is to define current practices in prenatal gastroschisis surveillance.MethodsAn online survey was circulated to the Society for Maternal Fetal Medicine (SMFM) providers. Questions focused on timing, type, and frequency of surveillance, proposed interventions, and the impact of gastroschisis defect diameter on plan of care.ResultsResponses were obtained from 150/1104 (14%) SMFM providers. The majority of respondents worked in practices in an academic setting (61%) and more than half (58%) had been in maternal fetal medicine (MFM) practice for > 10 years. Antenatal testing began at 32 weeks for 78% of MFM providers. Surveillance was unanimously uniformly performed with ultrasound. About 40% of the providers would consider all abnormalities in the measured parameters to change their surveillance frequency. In non-complicated gastroschisis, 44% of the providers would recommend delivery at 37 weeks of gestational age, with the vast majority of them (96%) recommending vaginal delivery. Among the 23% who expressed their thoughts, 70% agreed that a smaller defect size correlated with the higher risk for development of SBS. Nevertheless, only 2% declared an absolute cutoff point (< 8 mm–3 cm) at which they would recommend delivery. Only one-fifth of the participants (21%) noted that the abdominal wall defect size has an impact on development of SBS. A higher percentage of SMFM providers (89%) with ≤ 10 years of experience started the antenatal testing at week 32 weeks compared to 66% of senior providers. Senior providers were more inclined (50%) to induce labor at 37 weeks compared to SMFM providers with > 10 years of experience (38%).ConclusionsGastroschisis management does not differ dramatically among SMFM providers, though noticeable differences in surveillance and timing of induction were identified based on years of experience as providers. The impact of gastroschisis defect dimensions on development of SBS may be under appreciated.