The importance of serial biophysical assessment of fetal wellbeing in gastroschisis.
OBJECTIVE
To review antenatal and intrapartum assessment of pregnancies complicated by gastroschisis.


METHODS
Retrospective descriptive study.


METHODS
University College Hospital, London.


METHODS
24 consecutive cases of gastroschisis between 1986 and 1991.


RESULTS
The gestational age at sonographic diagnosis was 20.3 weeks (SD 6.77) and at birth was 36.5 weeks (SD 2.06). There were 21 live births, all with good surgical outcome. There were 16 vaginal deliveries and eight caesarean sections. The elective sections were for oligohydramnios and dilated bowel (1) and clinically suspected growth retardation (1); the intrapartum caesarean sections were for fetal distress (4) and premature breech presentation (2). There were six with dilated gut on ultrasound; one of these ended in a stillbirth. There was a significant association between gut dilatation and caesarean section for fetal distress (P = 0.004). There was also a significant association between meconium staining and fetal distress (P = 0.021). Of these babies, 46% were < or = third centile for corrected birth weight.


CONCLUSIONS
While half of the babies with gastroschisis were small for gestational age at birth, reliable antenatal prediction of birth weight is difficult. Gut dilatation may be an indicator of either antenatal or intrapartum fetal distress, but does not correlate with poor neonatal surgical outcome. We suggest close antenatal surveillance of fetal wellbeing in all cases of gastroschisis because, in addition to growth retardation, many show some evidence of fetal distress and 12.5% end in stillbirth, even when appropriately grown.
Crawford
R A
RA
Department of Fetal Medicine, University College Hospital, London, UK.
Ryan
G
G
Wright
V M
VM
Rodeck
C H
CH
D000009:Abdominal Muscles / Q000002:abnormalities*; D000022:Abortion, Spontaneous / Q000209:etiology; D000653:Amniotic Fluid / Q000737:chemistry; D001724:Birth Weight; D015148:Cardiotocography; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology / Q000503:physiopathology; D006340:Heart Rate, Fetal; D006801:Humans; D007751:Labor, Induced; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies