Is preterm delivery indicated in fetuses with gastroschisis and antenatally detected bowel dilation?
BACKGROUND
Due to the controversy surrounding diagnostic ultrasound evaluations and elective preterm delivery of fetuses with gastroschisis, we sought to calculate the predictive value of bowel dilation in fetuses with gastroschisis and evaluate the effect of preterm delivery on neonatal outcomes.


METHODS
Ultrasounds and medical records of 103 mother-infant pairs with fetal gastroschisis were reviewed. Eighty-nine pairs met the criteria. Intestinal complications, gestational age at delivery, birth weight, and number of abdominal surgeries were documented.


RESULTS
Forty-eight fetuses (54%) had bowel dilation and 41 (46%) did not. The positive predictive value of bowel dilation for complicated gastroschisis was 21%. There were 50 (56%) preterm and 39 (44%) term deliveries. The mean birth weight was 2,114 g (SD = 507) and 2,659 g (SD = 687), p = 0.001. For infants delivered preterm, the mean number of postnatal abdominal surgeries was 2.1 (SD = 1.1) as compared to 1.3 (SD = 0.5) surgical procedures for those infants delivered at term gestation. This was not statistically significant. With respect to hospital stay for each group, the mean length of neonatal intensive care unit admission was 48 days (SD = 33) in the preterm group and 35 days (SD = 50) in the term group, which was not statistically significant.


CONCLUSIONS
Ultrasound-detected bowel dilation was not predictive of important intestinal complications. Our data did not substantiate any benefit for elective preterm delivery of neonates with gastroschisis.
Junior League Center for Advanced Maternal Fetal Care, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
Megan S
MS
Wilson
Mary A
MA
Carroll
Stephane A
SA
Braun
William F
WF
Walsh
John B
JB
Pietsch
Kelly A
KA
Bennett
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000028:Abortion, Induced / Q000009:adverse effects; D000032:Abortion, Therapeutic / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003663:Decision Trees; D004108:Dilatation, Pathologic / Q000150:complications / Q000151:congenital / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007422:Intestines / Q000002:abnormalities* / Q000000981:diagnostic imaging; D007902:Length of Stay; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D055815:Young Adult