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.
Highlights
IntroductionGastroschisis (GS) is an abdominal wall defect diagnosed in prenatal care in more than
The variables investigated for ultrasound markers were intraabdominal bowel dilatation (IABD), extra-abdominal bowel dilatation (EABD), intrauterine growth restriction, polyhydramnios, intestinal wall thickness, bowel dilatation, liver and bladder herniation, delta dilatation and final bowel dilatation, abdominal circumference, herniation, dilation of the stomach, size, and position of stomach, size of the abdominal wall defect, description of mesenteric circulation, collapsed extra-abdominal bowel, description of peristalsis and volvulus
The meta-analysis indicated that the risk of predicting IABD is higher in fetuses with complex GS (RR 3.01, 95% confidence interval (CI) 2.22 to 4.08; I2 = 16%, p = 0.310)
Summary
Gastroschisis (GS) is an abdominal wall defect diagnosed in prenatal care in more than. Gastroschisis can be simple GS or complex GS and the intestinal condition at birth is an important prognostic factor for neonatal comorbidities [3,4]. The two types are differentiated due to the presence of complications in the gastrointestinal area that occurs in complex GS [3]. Complex GS is defined by the presence of congenital intestinal atresia, necrosis, stenosis, perforation, or volvulus [5,6]. GS is often diagnosed from prenatal ultrasound (US) [8], attempts have been made to correlate US findings with neonatal outcomes in pregnancies with fetal. The objective of this systematic review and meta-analysis is to investigate the ultrasound markers that characterize complex GS and can assist in screening, prenatal counseling, and medical treatment in order to minimize postnatal complications of complex GS
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