Am J Perinatol 2024; 41(03): 282-289
DOI: 10.1055/a-1673-0409
Original Article

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

Medina-Jiménez Virginia
1   Maternal and Fetal Medicine Department, The National Institute of Perinatology (INPer), Mexico
,
Acevedo-Gallegos Sandra
1   Maternal and Fetal Medicine Department, The National Institute of Perinatology (INPer), Mexico
,
Aguinaga-Rios Monica
2   Department of Genetics, The National Institute of Perinatology (INPer), Mexico
,
Gallardo-Gaona Juan Manuel
1   Maternal and Fetal Medicine Department, The National Institute of Perinatology (INPer), Mexico
› Institutsangaben
Funding None.

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.

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)




Publikationsverlauf

Eingereicht: 19. Oktober 2020

Angenommen: 08. Oktober 2021

Accepted Manuscript online:
19. Oktober 2021

Artikel online veröffentlicht:
10. Dezember 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 McKusick VA. Gastrosquisis. Online Mendelian Inheritance in Man. Accessed November 17, 2021 at: http://www.ncbi.nlm.nih.gov/omim/230750
  • 2 Castilla EE, Mastroiacovo P, Orioli IM. Gastroschisis: international epidemiology and public health perspectives. Am J Med Genet C Semin Med Genet 2008; 148C (03) 162-179
  • 3 Navarrete-Hernández E, Canún-Serrano S, Valdés-Hernández J, Reyes-Pablo AE. Malformaciones congénitas al nacimiento: México, 2008-2013. Bol Méd Hosp Infant México 2017; 74 (04) 301-308
  • 4 Molik KA, Gingalewski CA, West KW. et al. Gastroschisis: a plea for risk categorization. J Pediatr Surg 2001; 36 (01) 51-55
  • 5 Bergholz R, Boettcher M, Reinshagen K, Wenke K. Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality—a systematic review and meta-analysis. J Pediatr Surg 2014; 49 (10) 1527-1532
  • 6 Laje P, Fraga MV, Peranteau WH. et al. Complex gastroschisis: clinical spectrum and neonatal outcomes at a referral center. J Pediatr Surg 2018; 53 (10) 1904-1907
  • 7 D'Antonio F, Virgone C, Rizzo G. et al. Prenatal risk factors and outcomes in gastroschisis: a meta-analysis. Pediatrics 2015; 136 (01) e159-e169
  • 8 Kuleva M, Khen-Dunlop N, Dumez Y, Ville Y, Salomon LJ. Is complex gastroschisis predictable by prenatal ultrasound?. BJOG 2012; 119 (01) 102-109
  • 9 Emil S. Surgical strategies in complex gastroschisis. Semin Pediatr Surg 2018; 27 (05) 309-315
  • 10 Machuca Vaca AJ, Guido Ramíres O, Fernández Carrocera LA. et al. Gastrosquisis: resultados en una institución de tercer nivel. Vol. 31. Perinatol Reprod Hum 2017; 31: 68-72
  • 11 Lao OB, Larison C, Garrison MM. Outcomes in neonates with gastroschisis in U.S. children's hospitals. Am J Perinatol 2010; 27: 097-101
  • 12 Towers CV, Carr MH. Antenatal fetal surveillance in pregnancies complicated by fetal gastroschisis. Am J Obstet Gynecol 2008; 198 (06) 686.e1-686.e5 , discussion 686.e5
  • 13 Martillotti G, Boucoiran I, Damphousse A. et al. Predicting perinatal outcome from prenatal ultrasound characteristics in pregnancies complicated by gastroschisis. Fetal Diagn Ther 2016; 39 (04) 279-286
  • 14 Dore R, Triana J, Encinas H. et al. El edema mesentérico como signo ecográfico prenatal de mal pronóstico en gastrosquisis. Cir Pediatr 2017; 30: 131-137
  • 15 Robertson JA, Kimble RM, Stockton K, Sekar R. Antenatal ultrasound features in fetuses with gastroschisis and its prediction in neonatal outcome. Aust N Z J Obstet Gynaecol 2017; 57 (01) 52-56
  • 16 Andrade WS, Brizot ML, Rodrigues AS. et al. Sonographic markers in the prediction of fetal complex gastroschisis. Fetal Diagn Ther 2018; 43 (01) 45-52
  • 17 Perry H, Healy C, Wellesley D. et al. Intrauterine death rate in gastroschisis following the introduction of an antenatal surveillance program: retrospective observational study. J Obstet Gynaecol Res 2017; 43 (03) 492-497
  • 18 Brantberg A, Blaas H-GK, Salvesen KÅ, Haugen SE, Eik-Nes SH. Surveillance and outcome of fetuses with gastroschisis. Ultrasound Obstet Gynecol 2004; 23 (01) 4-13
  • 19 Melamed N, Baschat A, Yinon Y. et al. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynaecol Obstet 2021; 152 (Suppl. 01) 3-57
  • 20 Kirby RS, Marshall J, Tanner JP. et al; National Birth Defects Prevention Network. Prevalence and correlates of gastroschisis in 15 states, 1995 to 2005. Obstet Gynecol 2013; 122 (2 Pt 1): 275-281
  • 21 Osmundo Junior GS, Mohamed SHM, Nishie EN. et al. Association of spontaneous labor onset with neonatal outcomes in pregnancies with fetal gastroschisis: a retrospective cohort analysis. Acta Obstet Gynecol Scand 2019; 98 (02) 154-161
  • 22 Andrade WS, Brizot ML, Francisco RPV. et al. Fetal intra-abdominal bowel dilation in prediction of complex gastroschisis. Ultrasound Obstet Gynecol 2019; 54 (03) 376-380
  • 23 Fisher SG, Steinhardt NP, Howser LA, Bhamidipalli SS, Brown BP, Gray BW. It is complex: predicting gastroschisis outcomes using prenatal imaging. J Surg Res 2021; 58: 381-388
  • 24 Nicholas S, Stamilio D, Dicke J. et al. Predicting adverse neonatal outcomes in fetuses with abdominal wall defects using prenatal risk factors. Vol. 199. Am J Obstet Gynecol 2009; 201 (04) 383.e1-6
  • 25 Horton AL, Powell MS, Wolfe HM. Intrauterine growth patterns in fetal gastroschisis. Am J Perinatol 2010
  • 26 Zaki MN, Lusk LA, Overcash RT. et al. Predicting birth weight in fetuses with gastroschisis. J Perinatol 2018; 38 (02) 122-126
  • 27 Poola AS, Aguayo P, Fraser JD. et al. Primary closure versus bedside silo and delayed closure for gastroschisis: a truncated prospective randomized trial. Eur J Pediatr Surg 2019; 29 (02) 203-208
  • 28 Meyer MR, Shaffer BL, Doss AE, Cahill AG, Snowden JM, Caughey AB. Prospective risk of fetal death with gastroschisis. J Matern Fetal Neonatal Med 2015; 28 (17) 2126-2129
  • 29 Taylor JS, Shew SB. Impact of societal factors and health care delivery systems on gastroschisis outcomes. Semin Pediatr Surg 2018; 27 (05) 316-320