Comparison of Perinatal Outcomes between Patients with Suspected Complex and Simple Gastroschisis

Abstract

Objective The aim of this study was to compare perinatal outcomes between patients with and without prenatal ultrasound markers predictive of complex gastroschisis.

Study Design A prospective cohort of 98 patients with isolated fetal gastroschisis underwent antenatal ultrasound and delivered in a tertiary referral center. Patients were classified according to eight ultrasonographic markers predictive of complexity, and perinatal outcomes were assessed accordingly. The primary outcome was the presence of fetal growth restriction and staged SILO reduction postnatally.

Results Of all fetuses, 54.1% (n = 53) displayed ultrasonographic markers predictive of complexity at 32.7 ± 4.3 weeks of gestation. Gastric dilatation was the most frequent marker followed by extra-abdominal bowel dilatation. The presence of ultrasound markers predictive of complexity, was not associated with fetal growth restriction but its absence was less associated with staged SILO reduction of the abdominal wall postnatally with a relative risk of 0.79 (CI 95% 0.17–0.53).

Conclusion Fetuses with ultrasound markers that predict complexity were not associated with fetal growth restriction, but its absence was less associated with staged SILO reduction of the abdominal wall postnatally. It is necessary to unify criteria, establish cut-off points, and the optimal moment to measure these markers.

Key Points

• The association between ultrasound markers and adverse perinatal outcomes in fetuses with gastroschisis remain controversial.

• The absence of ultrasound markers that predict complexity was less associated with staged SILO reduction postnatally.

• It is necessary to unify criteria, establish cut-off points, and the optimal moment to measure these markers.

Keywords

gastroschisis - morbidity - prenatal ultrasound

Note

• What's already known about this topic? Gastroschisis is the most common abdominal wall defect, and the incidence of this congenital malformation is increasing in many countries. Complex gastroschisis increases morbidity and mortality rate, yet the usefulness of ultrasound markers predictive of complex gastroschisis remains controversial.

• What does this study add? Ultrasound markers predictive of complex gastroschisis were not associated with fetal growth restriction but its absence was less associated with staged SILO reduction of the abdominal wall postnatally with an RR of 0.79 (CI 95% 0.17–0.53)

Publication History

Received: 19 October 2020

Accepted: 08 October 2021

Accepted Manuscript online:
19 October 2021

Article published online:
10 December 2021

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