Outcomes of pregnancies with fetal gastroschisis.
OBJECTIVE
To describe pregnancy outcomes with fetal gastroschisis, including the associations of prenatal ultrasound findings with neonatal surgical complications and other morbidities.


METHODS
This was a review of pregnancies complicated by fetal gastroschisis and delivered from January 1998 through June 2006. The last ultrasonogram before delivery was reviewed to determine stomach dilatation, bowel dilatation, or abnormalities of amniotic fluid volume. Neonatal records were reviewed to determine type of closure and any bowel complications.


RESULTS
There were 66 pregnancies with gastroschisis, 1 per 2,000 deliveries. There were three stillbirths and three neonatal deaths. Delayed closure was necessary in 49% who underwent surgery. Birth weight below the third percentile, which occurred in 38%, was associated with need for delayed closure, 64% compared with 25% without growth restriction, P<.001, but was not associated with longer hospital stay or neonatal death. Fetal gastroschisis was diagnosed by prenatal ultrasonography in 58 cases. Bowel complications requiring surgery were more frequent when ultrasonography had demonstrated stomach dilatation (five cases), 60% compared with 10%, P=.002. Fetuses with defects so large that no normal ventral wall could be visualized ultrasonographically (three cases) were at increased risk for neonatal death, 100% compared with 0%, P<.001.


CONCLUSIONS
Ultrasound findings associated with adverse outcome in fetal gastroschisis included stomach dilatation and a defect so large that no normal ventral wall could be visualized. Fetal growth restriction was common, and such infants were more likely to require delayed gastroschisis closure. Despite more than 90% survival, morbidity with gastroschisis remains high.


METHODS
II.
Santiago-Munoz
Patricia C
PC
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9032, USA. patricia.santiago-munoz@utsouthwestern.edu
McIntire
Donald D
DD
Barber
Robert G
RG
Megison
Stephen M
SM
Twickler
Diane M
DM
Dashe
Jodi S
JS
D034861:Abdominal Wall / Q000002:abnormalities / Q000000981:diagnostic imaging; D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D005317:Fetal Growth Retardation / Q000453:epidemiology; D013271:Gastric Dilatation / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D020139:Gastroschisis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D050497:Stillbirth / Q000453:epidemiology; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods*