Prenatal extra-abdominal bowel dilatation is a risk factor for intrapartum fetal compromise for fetuses with gastroschisis.
OBJECTIVE
The aim of this study was to investigate the prenatal ultrasound features that were associated with intrapartum fetal distress in fetuses with gastroschisis.


METHODS
This was a retrospective observational study of all cases of gastroschisis referred to and delivering at the Mater Mothers' Hospital in Brisbane, Australia. Maternal demographics, prenatal ultrasound features including the presence of bowel dilatation, umbilical artery and middle cerebral artery Doppler indices and amniotic fluid volume as well as intrapartum outcome details were analysed using univariate and multivariate logistic regression to ascertain factors predictive of intrapartum compromise.


RESULTS
The study cohort included 155 cases of gastroschisis over a 16-year period. The overall perinatal loss rate was 5.9% (four intrauterine fetal deaths, four neonatal deaths and one termination of pregnancy). The live birth rate was 96.8% (150/155). Fetal heart rate abnormalities occurred in 55.1% of cases. The overall caesarean section rate was 40.9% (63/154), of which 63.5% (40/63) was emergency procedures. Both univariate and multivariate analysis confirmed that only extra-abdominal bowel dilatation was a risk factor for intrapartum fetal compromise necessitating emergency delivery.


CONCLUSIONS
Extra-abdominal bowel dilatation is a risk factor for intrapartum fetal compromise (OR 2.2; 95%CI 1.03-4.7) and emergent delivery.
Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Nicole
N
Brown
Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Mel
M
Nardi
Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.
Ristan M
RM
Greer
Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.|Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Scott
S
Petersen
Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.|Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Joseph
J
Thomas
Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.|Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Glenn
G
Gardener
Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.|Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Robert
R
Cincotta
Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.|Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Sailesh
S
Kumar
D000328:Adult; D000653:Amniotic Fluid / Q000000981:diagnostic imaging; D015331:Cohort Studies; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology*; D020139:Gastroschisis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D007422:Intestines / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging; D055815:Young Adult