1. Ultrasound markers for prediction of complex gastroschisis and adverse outcome
- Author
-
Gwendolyn T. R. Manten, Rene M. H. Wijnen, Chiara C. M. M. Lap, William L. M. Kramer, Titia E. Cohen-Overbeek, Eva Pajkrt, Caterina M. Bilardo, Dick Tibboel, Moska Aliasi, Lourens R. Pistorius, Eduard J. H. Mulder, Gerard H. A. Visser, Obstetrics and Gynaecology, APH - Personalized Medicine, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), Neonatology, Amsterdam Gastroenterology Endocrinology Metabolism, Obstetrics and gynaecology, Other Research, Pediatrics, Pediatric surgery, Obstetrics & Gynecology, Pediatric Surgery, RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrie & Gynaecologie, and MUMC+: MA Medische Staf Obstetrie Gynaecologie (9)
- Subjects
Polyhydramnios ,NEONATAL SURVIVAL ,INFANTS ,0302 clinical medicine ,Pregnancy ,INTESTINAL ATRESIA ,Abdomen ,Medicine ,Longitudinal Studies ,Prospective Studies ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Obstetrics ,ultrasound ,gastroschisis ,Obstetrics and Gynecology ,General Medicine ,intra-abdominal bowel diameter ,Stillbirth ,Original Papers ,Volvulus ,PRENATAL ULTRASOUND ,ETIOLOGY ,Intestines ,Pulsatile Flow ,intra‐abdominal bowel diameter ,Gestation ,Female ,Cohort study ,medicine.medical_specialty ,Biometry ,mesenteric artery ,Perforation (oil well) ,Gestational Age ,DIAGNOSIS ,Risk Assessment ,Ultrasonography, Prenatal ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,bowel ,Diagnosis, Differential ,03 medical and health sciences ,DELIVERY ,Fetus ,Mesenteric Artery, Superior ,Predictive Value of Tests ,FETUSES ,030225 pediatrics ,Humans ,Radiology, Nuclear Medicine and imaging ,ARTERY DOPPLER VELOCIMETRY ,Fetal Death ,Original Paper ,business.industry ,Gastroschisis ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Infant, Newborn ,Retrospective cohort study ,medicine.disease ,Logistic Models ,Reproductive Medicine ,Relative risk ,Linear Models ,business ,Biomarkers - Abstract
Contains fulltext : 220734.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To identify antenatal ultrasound markers that can differentiate between simple and complex gastroschisis and assess their predictive value. METHODS: This was a prospective nationwide study of pregnancies with isolated fetal gastroschisis that underwent serial longitudinal ultrasound examination at regular specified intervals between 20 and 37 weeks' gestation. The primary outcome was simple or complex (i.e. involving bowel atresia, volvulus, perforation or necrosis) gastroschisis at birth. Fetal biometry (abdominal circumference and estimated fetal weight), the occurrence of polyhydramnios, intra- and extra-abdominal bowel diameters and the pulsatility index (PI) of the superior mesenteric artery (SMA) were assessed. Linear mixed modeling was used to compare the individual trajectories of cases with simple and those with complex gastroschisis, and logistic regression analysis was used to estimate the strength of association between the ultrasound parameters and outcome. RESULTS: Of 104 pregnancies with isolated fetal gastroschisis included, four ended in intrauterine death. Eighty-one (81%) liveborn infants with simple and 19 (19%) with complex gastroschisis were included in the analysis. We found no relationship between fetal biometric variables and complex gastroschisis. The SMA-PI was significantly lower in fetuses with gastroschisis than in healthy controls, but did not differentiate between simple and complex gastroschisis. Both intra- and extra-abdominal bowel diameters were larger in cases with complex, compared to those with simple, gastroschisis (P < 0.001 and P < 0.005, respectively). The presence of intra-abdominal bowel diameter >/= 97.7(th) percentile on at least three occasions, not necessarily on successive examinations, was associated with an increased risk of the fetus having complex gastroschisis (relative risk, 1.56 (95% CI, 1.02-2.10); P = 0.006; positive predictive value, 50.0%; negative predictive value, 81.4%). CONCLUSIONS: This large prospective longitudinal study found that intra-abdominal bowel dilatation when present repeatedly during fetal development can differentiate between simple and complex gastroschisis; however, the positive predictive value is low, and therefore the clinical usefulness of this marker is limited. (c) 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
- Published
- 2020