F112Prenatal sonographic diagnosis and outcome of anterior abdominal wall defects

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Objectives(1) To evaluate the accuracy of routine second trimester ultrasound screening in the detection of anterior abdominal wall defects (AAWD); (2) To assess the outcome of these pregnancies.MethodsA retrospective study of low risk population between January 1993 to December 1999. Cases with AAWD were obtained from antenatal, neonatal surgical and pathology Departments. Correlation was made with the second trimester ultrasound examinations to assess the accuracy of detection. Pregnancy outcome was reviewed.ResultsThere were 25 fetuses with AAWD. 15 with omphalocoele, 9 with gastroschisis and 1 with bladder exstrophy. All except the bladder extrophy case were detected antenatally. Pathology report on a case of omphalocoele was inconclusive. A case of gastroschisis did not have histological confirmation following termination of pregnancy. However, sonogram review of these 2 cases confirmed the original diagnosis and hence are included as true positives. 7 of the 9 cases of gastroschisis were live births and all did well following surgery. 7 of the 15 cases of omphalocoele were livebirths. One died at 9 months but others did well post surgery.ConclusionWe demonstrate a sensitivity of 96% (24/25) and a specificity of 100% for the detection of AAWD. 13 of the 14 live births (93%) did well following surgery. With the increasing awareness of evidence based medicine, this study hopes to set a standard for clinical practice.