Antenatal ultrasound features in fetuses with gastroschisis and its prediction in neonatal outcome

Background: Gastroschisis is the most common major congenital anomaly managed by paediatric surgeons. The significance of certain associated antenatal ultrasound features in determining fetal outcome is under discussion.

Aim: The study aims to define if associated antenatal ultrasound features of gastroschisis are useful prognostic markers for fetal outcome. By establishing the significance of features, including extra- and intra-abdominal bowel dilatation, stomach herniation, stomach dilatation, bowel matting, growth restriction, abnormal umbilical artery (UA) Doppler ultrasounds, and abnormal amniotic fluid volume, it is hoped clinicians will have enhanced ability to counsel parents about the likely outcomes for their infant.

Materials and methods: Retrospective analysis of ultrasound images, reports and medical records of 101 pregnancies affected by fetal gastroschisis managed by the Royal Brisbane and Women's Hospital Maternal and Fetal Medicine Department over a 13 and a half year period was performed. The presence of ultrasound features during antenatal surveillance corresponded to fetal outcome measures, including the diagnosis of postnatal complex gastroschisis, the number of operations required, length of parenteral feeding and length of stay in neonatal intensive care.

Results: The only statistically significant predictor of complex cases of gastroschisis was extra-abdominal bowel dilatation. Although a statistically significant feature, approximately three-quarters (44/59) of all infants with gastroschisis with associated extra-abdominal bowel dilatation had simple gastroschisis.

Conclusions: Extra-abdominal bowel dilatation is a statistically significant marker of complex gastroschisis and associated morbidity. Its presence in infants who had uncomplicated outcomes, suggests that clinically, its usefulness in antenatal counselling is still debatable.