Bowel dilation as a predictor of adverse outcome in isolated fetal gastroschisis.

OBJECTIVES

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.