Bowel dilation as a predictor of adverse outcome in isolated fetal gastroschisis.
OBJECTIVE
This study was designed to evaluate bowel diameter as a predictor of adverse outcome in isolated fetal gastroschisis.


METHODS
Retrospective study involving 94 singleton pregnancies. Ultrasound measurements of herniated bowel transverse diameter (BTD) were performed up to 3 weeks before delivery. Adverse outcome was intrauterine/neonatal death and/or bowel complications.


RESULTS
Last BTD was recorded at 35.6 ± 1.6 weeks and mean interval to delivery was 6.2 ± 5.0 days. Intrauterine/neonatal death occurred in 10 (10.6%) cases; bowel complications were observed in 8 (8.5%). BTD ≥ 15, ≥ 20, ≥ 25, and ≥ 30 mm were found in 87, 46, 13, and 4% of pregnancies with a favorable outcome, respectively. BTD ≥ 25 mm sensitivity was 38%, and positive and negative predictive values were 38 and 87%. For BTD ≥ 30 mm, the values were 19, 50, and 85%. Observed/expected BTD ROC curve showed an area of 0.67, best cut-off value at 1.39; prediction values were similar to those for BTD ≥ 25 mm. Bowel dilatation was also significantly associated with lower rate of primary surgical closure, longer period to full oral feeding, and prolonged hospital stay.


CONCLUSIONS
Bowel dilatation demonstrated up to 3 weeks before delivery is a predictor of intestinal complications and is associated with lower rate of primary surgical closure, longer period to achieve full oral feeding, and hospital stay.
Garcia
L
L
Department of Obstetrics and Gynaecology, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil.
Brizot
M
M
Liao
A
A
Silva
M M
MM
Tannuri
A C
AC
Zugaib
M
M
D001938:Brazil / Q000453:epidemiology; D004108:Dilatation, Pathologic / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D005313:Fetal Death / Q000453:epidemiology; D020139:Gastroschisis / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D007422:Intestines / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal