Abstract
ObjectiveTo determine whether complex gastroschisis (ie, intestinal atresia, perforation, necrosis, or volvulus) can prenatally be distinguished from simple gastroschisis by fetal stomach volume and stomach‐bladder distance, using three‐dimensional (3D) ultrasound.MethodsThis multicenter prospective cohort study was conducted in the Netherlands between 2010 and 2015. Of seven university medical centers, we included the four centers that performed longitudinal 3D ultrasound measurements at a regular basis. We calculated stomach volumes (n = 223) using Sonography‐based Automated Volume Count. The shortest stomach‐bladder distance (n = 241) was determined using multiplanar visualization of the volume datasets. We used linear mixed modelling to evaluate the effect of gestational age and type of gastroschisis (simple or complex) on fetal stomach volume and stomach‐bladder distance.ResultsWe included 79 affected fetuses. Sixty‐six (84%) had been assessed with 3D ultrasound at least once; 64 of these 66 were liveborn, nine (14%) had complex gastroschisis. With advancing gestational age, stomach volume significantly increased, and stomach‐bladder distance decreased (both P < .001). The developmental changes did not differ significantly between fetuses with simple and complex gastroschisis, neither for fetal stomach volume (P = .85), nor for stomach bladder distance (P = .78).ConclusionFetal stomach volume and stomach‐bladder distance, measured during pregnancy using 3D ultrasonography, do not predict complex gastroschisis.
Highlights
Gastroschisis is an abdominal wall defect that is diagnosed prenatally in over 90% of the cases, usually before 23 weeks' gestation.1 In countries that offer routine ultrasound scans at 11 to 14 weeks' gestation, gastroschisis is usually diagnosed in the first trimester.2 This allows for early parental counseling and adjustment of obstetric management.Seventeen percent of all neonates with gastroschisis are diagnosed with additional intestinal defects at birth, ie, intestinal atresia, perforation, necrosis, or volvulus.3,4 Infants with complex gastroschisis have a higher risk of morbidity than those with simple gastroschisis; they often experience prolonged time to full enteral feeding (TFEF), more complications, and prolonged length of hospital stay (LOS).3-6Prenatal detection or prediction of complex gastroschisis would lead to more complete parental counseling
Two (3%) of these pregnancies resulted in intra‐uterine demise (IUD) at 28 and 33 weeks' gestation, respectively, and nine of the remaining 64 (14%) live born neonates were diagnosed with complex gastroschisis
For the two pregnancies resulting in IUD, we found fetal stomach volume and stomach‐bladder distance comparable to those shown in Figures 4 and 5, respectively
Summary
Gastroschisis is an abdominal wall defect that is diagnosed prenatally in over 90% of the cases, usually before 23 weeks' gestation. In countries that offer routine ultrasound scans at 11 to 14 weeks' gestation, gastroschisis is usually diagnosed in the first trimester. This allows for early parental counseling and adjustment of obstetric management.Seventeen percent of all neonates with gastroschisis are diagnosed with additional intestinal defects at birth, ie, intestinal atresia, perforation, necrosis, or volvulus (defined as complex gastroschisis). Infants with complex gastroschisis have a higher risk of morbidity than those with simple gastroschisis; they often experience prolonged time to full enteral feeding (TFEF), more complications, and prolonged length of hospital stay (LOS).3-6Prenatal detection or prediction of complex gastroschisis would lead to more complete parental counseling. Gastroschisis is an abdominal wall defect that is diagnosed prenatally in over 90% of the cases, usually before 23 weeks' gestation.. In countries that offer routine ultrasound scans at 11 to 14 weeks' gestation, gastroschisis is usually diagnosed in the first trimester.. In countries that offer routine ultrasound scans at 11 to 14 weeks' gestation, gastroschisis is usually diagnosed in the first trimester.2 This allows for early parental counseling and adjustment of obstetric management. The association between two‐dimensional (2D) prenatal ultrasound findings (eg, bowel dilatation, stomach dilatation, or amniotic fluid index) and complex gastroschisis has been investigated in a number of studies, which showed conflicting results.. Fetal stomach dilatation has been associated with neonatal death, but not with complex gastroschisis.. Three‐dimensional (3D) ultrasound might be more accurate in measuring fetal stomach volume and predicting complex gastroschisis, but to date there are no studies to support this hypothesis
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