Gastroschisis: Prenatal Evaluation of Prognostic Factors for Postnatal Outcome - Revista Brasileira de Ginecologia e Obstetrícia
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):421-428
Purpose: to evaluate 24 cases of gastroschisis, in relation to the prognostic factors that interfered with postnatal outcome. Patients and Method: twenty-four pregnancies with fetal prenatal ultrasound diagnosis of gastroschisis, during an 8-year period, were analyzed. Gastroschisis was classified into isolated, when there were no other structural abnormalities, or associated, when other abnormalities were present. For both groups the following parameters were examined: ultrasound bowel dilatation (>18 mm), obstetric complications and postnatal outcome. Nonparametric Mann-Whitney and exact Fisher’s tests were used for statistical analyses. Results: in 9 cases (37.5%) gastroschisis was associated with other abnormalities, and in 15 cases it was isolated (62.5%). All cases of associated gastroschisis had a letal prognosis, therefore the overall mortality rate was 60.8%. In the group of isolated gastroschisis, all were born alive and were submitted to surgery, but the survival rate after surgical correction was 60%. The median gestational age at birth was 35 weeks and birth weight 2,365 grams. Premature delivery was observed in 10 cases, mainly as a consequence of obstetric complication. Two newborns were small for gestational age, and only 3 had birth weight >2,500 grams. Oligohydramnios was found in 46.6% and it was more frequent in the group of postnatal death (66.7%). Ultrasound assessment of bowel showed bowel dilatation in 86.6%, however, without relation to the prognosis and postnatal bowel findings. There was no significant difference between gestational age at birth and birth weight comparing the survivor and postnatal death groups. Conclusions: isolated gastroschisis had a better prognosis when compared to associated, therefore this prenatal differentiation is important. Isolated gastroschisis was often associated with prematurity, small birth weight and obstetric complications. Prenatal diagnosis allows better monitoring of fetal and obstetric conditions. Delivery should be at term, unless presenting with obstetric complications.
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Purpose: to evaluate 24 cases of gastroschisis, in relation to the prognostic factors that interfered with postnatal outcome. Patients and Method: twenty-four pregnancies with fetal prenatal ultrasound diagnosis of gastroschisis, during an 8-year period, were analyzed. Gastroschisis was classified into isolated, when there were no other structural abnormalities, or associated, when other abnormalities were present. For both groups the following parameters were examined: ultrasound bowel dilatation (>18 mm), obstetric complications and postnatal outcome. Nonparametric Mann-Whitney and exact Fisher's tests were used for statistical analyses. Results: in 9 cases (37.5%) gastroschisis was associated with other abnormalities, and in 15 cases it was isolated (62.5%). All cases of associated gastroschisis had a letal prognosis, therefore the overall mortality rate was 60.8%. In the group of isolated gastroschisis, all were born alive and were submitted to surgery, but the survival rate after surgical correction was 60%. The median gestational age at birth was 35 weeks and birth weight 2,365 grams. Premature delivery was observed in 10 cases, mainly as a consequence of obstetric complication. Two newborns were small for gestational age, and only 3 had birth weight >2,500 grams. Oligohydramnios was found in 46.6% and it was more frequent in the group of postnatal death (66.7%). Ultrasound assessment of bowel showed bowel dilatation in 86.6%, however, without relation to the prognosis and postnatal bowel findings. There was no significant difference between gestational age at birth and birth weight comparing the survivor and postnatal death groups. Conclusions: isolated gastroschisis had a better prognosis when compared to associated, therefore this prenatal differentiation is important. Isolated gastroschisis was often associated with prematurity, small birth weight and obstetric complications. Prenatal diagnosis allows better monitoring of fetal and obstetric conditions. Delivery should be at term, unless presenting with obstetric complications.
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