Influence of antenatal ultrasound on the management of fetal exomphalos.
OBJECTIVE
To determine the influence of antenatal ultrasound on the management of exomphalos.


METHODS
Retrospective case note review of 23 fetuses and infants referred to our institution with either a pre- or postnatal diagnosis of exomphalos over a 7-year period.


RESULTS
There were 21 cases of exomphalos of which 18 were correctly diagnosed on antenatal ultrasound by 18 weeks' gestation. There were 2 false-positives and 3 false-negatives, including 1 case of amniotic band syndrome with an abdominal wall defect and 1 morphologically normal fetus. Associated anomalies were correctly identified in 12 but incorrectly reported in 8. Maternal serum alpha-fetoprotein levels were abnormal in 61% of cases of abdominal wall defects in this series. Amniocentesis was performed in 12 and cordocentesis in 1. There were 13 terminations, including 2 trisomy 18s and 1 trisomy 13. Two fetal deaths followed amniocentesis. Of the 10 live births, 9 had their exomphalos repaired with a 1-year survival rate of 89%. Prenatal diagnosis did not appear to influence outcome.


CONCLUSIONS
Antenatal ultrasound diagnosed 86% of cases of exomphalos and correctly reported 67% of associated anomalies. Amniocentesis may have led to the death of 1 morphologically normal fetus.
Holland
A J
AJ
Department of Paediatric Surgery, Division of Surgery, Division of Medical Imaging, Women's and Children's Hospital, Adelaide, S.A., Australia.
Ford
W D
WD
Linke
R J
RJ
Furness
M E
ME
Hayward
C
C
D000025:Abortion, Eugenic; D000293:Adolescent; D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects; D003951:Diagnostic Errors; D005260:Female; D006554:Hernia, Umbilical / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins