Gastroschisis: can antenatal ultrasound predict infant outcomes?
OBJECTIVE
To test previously proposed but unproven antenatal ultrasound prognostic criteria in fetal gastroschisis.


METHODS
Thirty consecutive gastroschisis-affected pregnancies and their outcomes were reviewed retrospectively. Data were tabulated by review of antenatal ultrasound videotapes, with blinded comparison to indicators of short- and long-term infant outcomes obtained from the medical records. Criteria of previous reports were applied to these data, focusing on their ability to prognosticate effectively.


RESULTS
Applying a criterion of 10 mm bowel dilatation proved minimally useful in prognosticating infant outcomes. However, a stricter 17-mm criterion for clinically important bowel dilatation provided prognostic information, with remarkable improvement in specificity (75 versus 37%) and positive predictive value (55 versus 37%) for infant morbidity, with comparatively little loss of sensitivity (71 versus 85%).


CONCLUSIONS
Bowel dilated more than 17 mm on antenatal ultrasound appears to be associated with increased short- and long-term infant morbidity. Whether this finding warrants obstetric intervention in the preterm gastroschisis-affected pregnancy with substantial bowel dilatation remains to be determined.
Pryde
P G
PG
Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University, Detroit, Michigan.
Bardicef
M
M
Treadwell
M C
MC
Klein
M
M
Isada
N B
NB
Evans
M I
MI
D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013270:Stomach / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal