Amnioexchange for fetuses with gastroschisis: is it effective?
OBJECTIVE
Amniotic fluid of fetuses with gastroschisis (GS) contains inflammatory mediators, gastrointestinal, and urinary waste products. Dilution and removal of such harmful substances have been advocated to prevent damage to the herniated intestine. We evaluated the effectiveness of serial amnioexchange procedures in 8 consecutive fetuses with GS.


METHODS
Amnioexchange was performed bimonthly during the third trimester. Amniotic fluid collected before each procedure was tested for pH, osmolarity, urea, creatinine, cystatin-C, proteins, albumin, bilirubin, biliary salts, pancreatic amylase, serum amyloid A, C-reactive protein, alanine transaminase (ALT), alcaline phosphatase (ALP), gamma-glutamyl transpetidase (gammaGT), tumor necrosis factor alpha, interleukin 2, interleukin 6, epidermal growth factor, transforming growth factor beta, and myeloperoxidase.


RESULTS
A total of 25 samples (median, 3 per fetus) were examined. Biochemical or inflammatory markers did not correlate with gestational age, nor was any trend observed in values from individual patients during the course of amnioexchange treatment. There was no correlation between biochemical or inflammatory markers and clinical outcome, including time to full enteral feeding.


CONCLUSIONS
Serial amnioexchanges did not modify the biochemical or inflammatory status of amniotic fluid nor appeared to prevent injury to the herniated gut. Because repeated amnioexchanges may carry some risks, their use in fetuses with GS is not recommended outside the setting of a prospective randomized trial.
Midrio
Paola
P
Paediatric Surgery Unit, University of Padova, 35121 Padova, Italy. midrio@pediatria.unipd.it
Stefanutti
Giorgio
G
Mussap
Michele
M
D'Antona
Donato
D
Zolpi
Elisa
E
Gamba
Piergiorgio
P
D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry*; D015415:Biomarkers / Q000032:analysis*; D004322:Drainage / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000628:therapy*; D020139:Gastroschisis / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D018836:Inflammation Mediators / Q000032:analysis*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third
D015415:Biomarkers; D018836:Inflammation Mediators