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Intraabdominal dilatation in fetuses with gastroschiss is associated with increased number of operations in the neonatal period

      Objective

      Previous studies have compared prenatal ultrasound findings with neonatal outcomes in fetuses with gastroschisis to find predictors of adverse events. We attempted to determine if fetal intraabdominal dilatation had an impact on neonatal outcome.

      Study design

      We compared 27 mother-child pairs with prenatal diagnosis of fetal gastroschisis to neonatal outcomes. Findings of stomach and intraabdominal dilatation were compared with total number of operations, days of respiratory support, days of parenteral nutrition, number of post-op days until oral feedings were started and age at discharge.

      Results

      Fetuses prenatally diagnosed with intraabdominal dilatation required an increased number of operations. Stomach dilatation independently was associated with significantly more days of respiratory support (ventilatory and continued positive airway pressure). Presence of meconium or IUGR did not change any of the post-operative outcomes. Fifty percent (13/27) of neonates had bowel abnormalities detected during surgery. Malrotation was the most common (10/13), followed by atresia and stenosis (3/13). 4/13 neonates with bowel abnormalities were born to pregnancies complicated by meconium.

      Conclusion

      Fetuses with gastroschisis that have dilatation of the bowels or the stomach area at a greater risk for repeat operations and ventilatory support. Findings of IUGR or moderate to thick meconium in the amniotic fluid did not change the neonatal outcome.
      Tabled 1Intraabdominal dilatation and neonatal outcome
      Stomach dilatationIntraabdominal dilatation
      Present n = 7Absent n = 20P valuePresent n = 19Absent n = 8P value
      Total No. operations2.28 ± .101.70 ± .86.072.05 ± 0.911.38 ± 0.74.04
      No. days on respiratory support8.5 ± 7.344.2 ± 3.18.055.94 ± 5.393.5 ± 1.85NS
      Days of parenteral feedings20.0 ± 12.9418.5 ± 12.09NS20.58 ± 13.6014.87 ± 6.33NS