Is unexplained third trimester intrauterine death of fetuses with gastroschisis caused by umbilical cord compression due to acute extra-abdominal bowel dilatation?
We report on a case of gastroschisis in which sudden dilatation of extra-abdominal bowel at 34+1 weeks was followed by an unusual umbilical flow velocity waveform (diastolic notching). The condition was associated with normal umbilical Doppler indices, brain sparing effect and a non-reactive cardiotocograph (CTG). Findings at postnatal surgery strongly suggested severe cord compression by the herniated dilated bowel. The significance of notching in the umbilical artery waveform is discussed, as is the potential importance of this sign in the prepartum management of fetuses with gastroschisis.
Kalache
Karim D
KD
Fetal Medicine Unit, Department of Obstetrics and Gynecology, Campus Charité Mitte, University Hospital - Medical Faculty of the Humboldt-University, Berlin, Germany. kalachek@mail.nih.gov
Bierlich
Anke
A
Hammer
Hannes
H
Bollmann
Rainer
R
D000328:Adult; D003241:Consanguinity; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D004108:Dilatation, Pathologic; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D020139:Gastroschisis / Q000000981:diagnostic imaging / Q000401:mortality*; D005865:Gestational Age; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging / Q000473:pathology*; D017078:Laser-Doppler Flowmetry; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000503:physiopathology; D014470:Umbilical Cord