Prenatal Bowel Dilatation Research Articles

Analysis of the clinical outcomes of fetal bowel dilatation combined with other abnormal ultrasonographic features

Objectives: To explore the significance of fetal bowel dilatation combined with other abnormal ultrasound features in the diagnosis of gastrointestinal malformation.Methods: A retrospective study of fetuses with bowel dilatation was performed, from August 2012 to October 2015. All the cases were identified from the ultrasound database and all observations of the relationship of prenatal abnormal abdominal ultrasound features and intestinal malformation were performed through the infancy stage.Results: We found 52 fetuses with prenatal suspicion of bowel dilatation. Of these, 20 cases were surgically confirmed to have intestinal malformation, 13 cases had no abnormal bowel loops after birth, 8 cases had abnormal intestinal features while no surgical intervention was performed after birth, 10 cases were lost to follow-up and 1 fetus died in utero at 34 weeks of gestation. Forty cases with full data were divided into three groups, including Group A (Small bowel dilatation combined with other features vs. Isolated small bowel dilatation), Group B (Colonic bowel dilatation combined with other features vs. Isolated colonic bowel dilatation) and Group C (Bowel dilatation combined with other features vs. Isolated bowel dilatation). The intestinal malformation occurrence rates were 73.33% vs. 31.25% in Group A, 50% vs. 25% in Group B, and 70% vs. 30% in Group C. These results suggest that malformation occurs at a lesser frequency in simple bowel dilatation versus bowel dilatation in combination with other abnormal ultrasound features (p = .026), similarly in simple small bowel dilatation versus small bowel dilatation in combination with other abnormal ultrasound features (p = .032).Conclusions: Prenatal bowel dilatation in combination with other abnormal ultrasound features, especially small bowel dilatation in combination with other abnormal ultrasound features, detected in the second and third trimesters, tended to indicate intestinal malformation, which contributes to enhance the accuracy of prenatal diagnosis of intestinal malformation.

Segmental absence of intestinal musculature with metachronous bowel perforations in an infant

Abstract Segmental absence of intestinal musculature is a rare condition. A female patient was born at 39 weeks gestational age with birth weight of 2,900 g. The patient was prenatally diagnosed as having segmental bowel distension in the fetal stage. She manifested bilious emesis with abdominal distension at day 1. Although excretion of viscous meconium was observed by gastrografin enema, gastrointestinal perforation developed. Emergency laparotomy and peritoneal drainage was required at that time and further laparotomy was performed on day 15. Multiple perforations were recognized discontinuously from the jejunum to the transverse colon, and jejunostomy was constructed. Additional bowel perforations occurred and re-exploration was required at day 43. We found newly formed small perforations in the proximal jejunum, ileum and the transverse colon and a tube jejunostomy and a colostomy were established. The patient required prolonged TPN management, which induced correlated cholestasis and liver failure, and died at day 143. Pathologic findings showed partial hypoplasia of the intrinsic muscle layer in the small intestine and diagnosed as segmental absence of intestinal musculature. Her disorder was unusual in its presentation, which included prenatal bowel dilatation, metachronous superimposed bowel perforation, and extensive discrete lesions from the jejunum to the transverse colon.

378: Prenatal bowel dilation: correlation between ultrasound, fetal MRI, and postnatal outcome

378: Prenatal bowel dilation: correlation between ultrasound, fetal MRI, and postnatal outcome

Fetal Gastroschisis: A Comparison of Second vs. Third-Trimester Bowel Dilatation for Predicting Bowel Atresia and Neonatal Outcomes

To compare various gestational ages and thresholds for diagnosing bowel dilatation in fetuses with gastroschisis and to evaluate the prognostic value of bowel dilatation for predicting postnatal bowel atresia and neonatal outcomes. This was a retrospective observational study conducted from March 1997 to September 2009 that included 78 pregnancies with fetal gastroschisis. The predictive value of prenatal bowel dilatation for neonatal bowel atresia and postnatal complications was investigated in three subgroups: those with bowel dilatations ≥ 10 mm at a gestational age < 27 + 0 weeks, ≥ 10 mm at a gestational age < 30 + 0 weeks and ≥ 18 mm at a gestational age ≥ 30 weeks. Prenatally, 6 %, 81 % and 13 % of the bowel malformations were identified in the first, second and third trimesters, respectively. There were three stillbirths and three neonatal deaths, and the mean gestational age at delivery was 35.4 weeks (range 31 + 4 to 41 + 6). Bowel atresia was significantly correlated with prenatal bowel dilatation in all three subgroups. Bowel dilatations of ≥ 10 mm before 30 + 0 gestational weeks achieved the best performance in predicting bowel atresia, with a sensitivity of 89 % (8 / 9) and a specificity of 79 % (30 / 38). A prenatal bowel diameter ≥ 10 mm through 30 completed weeks was also the best predictor of a prolonged neonatal hospital stay ≥ 8 weeks (sensitivity = 61.1, 11 / 18, p = 0.002). Fetuses with isolated gastroschisis successfully underwent postnatal surgery in most cases (93.2 %), except for one termination, one intrauterine death and 3 cases of neonatal death. A fetal bowel dilatation > 10 mm before 30 + 0 weeks had the highest predictive value for postnatal bowel complications.

P22.06: Prenatal bowel dilatation and congenital chloride diarrhea: a case report

Congenital chloride diarrhoea (CCD) is a rare autosomal recessive disorder in which the transport of chloride in the distal ileum is disrupted. This is medically treatable condition but is easy to be misdiagnosed as a surgically treatable condition such as small-bowel atresia. A 28-year-old primigravida woman was referred at 34 weeks 2 days for evaluation of fetal dilated bowel loops and polyhydramnios. Her familial and medical histories were unremarkable. A sonographic examination showed a single fetus with generalized dilatation of the bowel in right side of the abdomen and polyhydramnios (amniotic fluid index, 30.48). Serial follow-up scans showed no notable change. Fetal growth was appropriate for the gestational age. We suspected distal small bowel obstruction or ileal atresia and consulted to pediatric surgery for postnatal surgery. At 37 weeks 2 day, she was admitted for premature rupture of membrane. The next day she had an uneventful spontaneous delivery of a female infant. After birth the neonate had slightly distended abdomen and yellowish watery diarrhoea without meconium passage. An infantogram after birth showed mild bowel gas distension without evidence of intestinal obstruction, small bowel series showed no small bowel transit time delay and diffuse gas distended colon without obstruction. She had hyponatremic metabolic alkalosis and hypochloridemia. The stool chloride concentration was high, 101 mmol/L (reference value < 90 mmol/L), confirming the diagnosis of CCD. She was discharged with sodium chloride for electrolyte correction. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome?

The prenatal or postnatal factors that predict complex gastroschisis in patients (atresia, volvulus, necrotic bowel and bowel perforation) remain controversial. We evaluated the prognostic value of prenatal ultrasonographic parameters and early postnatal factors in predicting clinical outcomes. We analyzed maternal and neonatal records of 46 gastroschisis patients treated from 1998 to 2007. Information regarding demographics, prenatal ultrasound data when available, intrapartum and postnatal course was abstracted from medical records. Outcome variables included survival, ventilator days, TPN days, time to full enteral feeds, complications and length of stay. Univariate or multivariate analysis was used, with P < 0.05 considered as significant. A total of 75% of complex patients were categorized within 1 week of life. Interestingly, prenatal bowel dilation (>17 mm) and thickness (>3 mm) did not correlate with outcome or risk stratification into simple versus complex (P < 0.05). Complex patients had increased morbidity compared to simple patients (sepsis 58 versus 18%; P = 0.021, NEC 42 versus 9%; P = 0.020, short bowel syndrome 58 versus 3%; P = 0.0001, ventilator days 24 versus 10; P = 0.021; TPN days 178 versus 38; P = 0.0001 and days to full feeds 171 versus 31; P = 0.0001; and length of stay 90 versus 39 days, P = 0.0001). Prenatal bowel wall dilation and/or thickness did not predict complex patients or adverse outcome. Complex gastroschisis patients can be identified postnatally and have substantial morbidity.

The outcome of gastroschisis after a prenatal diagnosis or a diagnosis only at birth: Recommendations for prenatal surveillance

Objectives To establish in infants with gastroschisis whether outcome is different when comparing a prenatal diagnosis with a diagnosis only at birth with the intention to develop a prenatal surveillance protocol. Intestinal atresia established after birth and preterm versus term delivery were studied as risk factors. Study design All 24 fetuses and 9 infants diagnosed with gastroschisis and referred to our tertiary center between January 1991 and June 2003 were studied retrospectively. Results The infants of the prenatal subset delivered at our tertiary center and 18 survived. There were two pregnancy terminations, three intrauterine deaths at 19, 33 and 36 weeks respectively and one neonatal death. All nine infants in the postnatal subset survived. Eight were out born and one was delivered at our tertiary center. Prenatal bowel dilatation did not correlate with outcome. Between the prenatal and postnatal subset no significant difference in outcome of live-born infants was established. For four infants with intestinal atresia a significant difference was demonstrated for induction of preterm labour ( P < 0.05), duration of parenteral nutrition ( P < 0.01), number of additional surgical procedures ( P < 0.001) and length of hospital stay ( P < 0.01). The fifteen infants born prior to 37 weeks of gestation spent a significantly longer period in hospital compared to those delivered at term. When the cases with bowel atresia were excluded this difference was no longer present. Five of the 33 cases were diagnosed with associated anomalies which mainly involved the urinary tract. Conclusion Neonatal outcome of live born infants following a prenatal diagnosis of gastroschisis is not different from a diagnosis at birth. The presence of intestinal atresia is the most important prognostic factor for morbidity. The supplemental value of prenatal diagnosis to the outcome of infants with gastroschisis may be in the prevention of unnecessary intrauterine death and detection of intestinal complications. A proposed surveillance protocol for fetuses with gastroschisis focused on intrauterine signs of pending distress such as a dilated stomach, intra abdominal bowel dilatation with peristalsis, notches in the umbilical artery Doppler signal, development of polyhydramnios and an abnormal CTG registration may improve outcome.

The impact of prenatal bowel dilation on clinical outcomes in neonates with gastroschisis

Purpose In fetuses with gastroschisis, the importance of ultrasonographic bowel dilation remains controversial. The outcome of patients with gastroschisis with and without prenatal bowel dilation is reported. Methods From 2000 to 2004, 27 neonates with gastroschisis were followed at a single center. Thirteen patients had prenatal ultrasonographic bowel dilation (diameter, ≥6 mm; range, 6-35 mm). Outcomes of those with and without dilation were compared using 2 sample t tests and logistic regression. Results Time to initiation of enteral nutrition varied significantly between groups (20.4 ± 11.7 days vs 12.5 ± 4.3 days, P < .05). A trend toward a reduced rate of primary closure was seen in those with dilation (23% vs 50%, P = .06). No significant difference was found when considering mortality, gestational age, time in the intensive care unit (ICU), time on parenteral nutrition, or length of stay. Prenatal bowel dilation, a longer ICU stay, and later gestational age independently predicted readmission for bowel obstruction ( P < .001). Conclusion Infants with gastroschisis and prenatal bowel dilation were significantly slower to initiate enteral feeding and tended to have a reduced incidence of primary closure. This did not translate into increased mortality, time on parenteral nutrition, time in the ICU, or length of stay. However, dilation was associated with readmission for bowel obstruction.