Fetal home monitoring for the prenatal management of gastroschisis.
BACKGROUND
Fetal distress is a frequent complication of gastroschisis, and could be screened for by home monitoring, as many pregnant women expecting an affected child live far away from a specialized perinatal center. This study was undertaken to audit a policy of fetal home monitoring (FHM) to achieve early detection of fetal heart rate (FHR) abnormalities in gastroschisis.


METHODS
Daily FHM was started at a median age of 30 weeks in 31 pregnant women referred following prenatal diagnosis of isolated gastroschisis. Monitoring was considered abnormal in cases with decelerations, tachycardia, bradycardia, decreased baseline variability or absence of accelerations. When an ominous FHR was detected and confirmed by in-hospital monitoring, an emergency cesarean section (C-section) was indicated. Otherwise, an elective C-section was planned.


RESULTS
In 20 cases FHM remained normal. There were 16 elective C-sections, two emergency C-sections for FHR abnormalities detected by in-hospital monitoring, and two spontaneous premature vaginal deliveries. In 11 cases, an abnormal FHM was detected. There was one intrauterine death with acute ischemic necrosis of the large bowel. The other abnormalities consisted of decreased baseline variability with tachycardia (n = 7) or without tachycardia (n = 3) and were confirmed by in-hospital follow-up in nine cases, leading to emergency C-section.


CONCLUSIONS
The high rate of abnormal FHR patterns picked up by FHM in gastroschisis led to a rate of emergency C-sections of 9/31. However, this strategy failed to prevent one intrauterine death due to acute bowel necrosis.
Salomon
Laurent J
LJ
Services de Maternité, Hôpital Necker-Enfants Malades, Paris, France.
Mahieu-Caputo
Dominique
D
Jouvet
Philippe
P
Jouannic
Jean-Marie
JM
Benachi
Alexandra
A
Grebille
Anne-Gaelle
AG
Dumez
Yves
Y
Dommergues
Marc
M
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology / Q000517:prevention & control*; D005323:Fetal Monitoring / Q000379:methods*; D005602:France / Q000453:epidemiology; D020139:Gastroschisis / Q000196:embryology / Q000453:epidemiology / Q000517:prevention & control*; D006340:Heart Rate, Fetal; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D012189:Retrospective Studies