Advertisement
Poster session II Diabetes, labor, medical-surgical-disease, obstetric quality & safety, prematurity, ultrasound-imaging: Abstracts 237 – 386| Volume 206, ISSUE 1, SUPPLEMENT , S157-S158, January 01, 2012

335: The degree of fetal bowel dilation as a predictor of postnatal surgery: risk stratification by the degree of dilation

      Objective

      Prenatal ultrasound diagnosis of fetal bowel dilation is associated with a number of gastrointestinal diagnoses and suggests the presence of bowel obstruction, but is non-specific. Our objective is to evaluate ultrasound diagnosis of the degree of fetal bowel dilation and its correlation with postnatal outcome and need for surgery.

      Study Design

      This is a retrospective chart review of fetuses with a prenatal diagnosis of bowel dilation. Patients that were followed antenatally, delivered, and managed postnatally at our institution from January 2004 until December 2010 were included in the study. Maximal bowel diameters were compared using gestational age normograms at the 50th and 90th percentiles, and the degree of dilation was calculated. The degree of bowel was determined by the percentage increase over the 90th percentile. Data collected also included gestational age at delivery, mode of delivery, postnatal surgery, surgical diagnosis, and neonatal length of stay. The cases were grouped into 2 categories: surgical (excluding abdominal wall defects), and medical.

      Results

      During this time period, 38 infants with a prenatal diagnosis of bowel dilation were identified: 13 surgical, and 25 non-surgical (medical). There were no differences between groups with respect to gestational age at delivery, infant gender, mode of delivery, birthweight, and gestational age at maximal bowel dilation. Infants requiring surgery had statistically significant maximal bowel dilation at 50% and 100% increases over the 90th percentile (p=.02, p=.004). These infants also had significantly higher maximal bowel diameters (p=0.01), and hospital length of stay (p=.007) (Table).
      Tabled 1
      Table thumbnail grt45

      Conclusion

      Prenatal diagnosis of bowel dilation is concerning and may suggest the presence of bowel obstruction requiring surgical intervention. Our data show that the degree of bowel dilation antenatally may be a better predictor in determining those infants most likely to require surgery. Further examination of surgical cases is required to determine the degree to which ultrasound diagnosis of bowel dilation can predict surgical diagnosis.