Ultrasound markers for prediction of complex gastroschisis and adverse outcome: longitudinal prospective nationwide cohort study.

Autor: Lap CCMM; Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands., Pistorius LR; Department of Obstetrics and Gynecology, University of Stellenbosch, Stellenbosch, South Africa., Mulder EJH; Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands., Aliasi M; Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands., Kramer WLM; Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Bilardo CM; Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands., Cohen-Overbeek TE; Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands., Pajkrt E; Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands., Tibboel D; Department of Pediatric Surgery and Intensive Care Children, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands., Wijnen RMH; Department of Pediatric Surgery and Intensive Care Children, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands., Visser GHA; Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands., Manten GTR; Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands.; Department of Obstetrics, Isala Women and Children's Hospital, Zwolle, The Netherlands.
Jazyk: angličtina
Zdroj: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology [Ultrasound Obstet Gynecol] 2020 Jun; Vol. 55 (6), pp. 776-785.
DOI: 10.1002/uog.21888
Abstrakt: Objectives: To identify antenatal ultrasound markers that can differentiate between simple and complex gastroschisis and assess their predictive value.
Methods: This was a prospective nationwide study of pregnancies with isolated fetal gastroschisis that underwent serial longitudinal ultrasound examination at regular specified intervals between 20 and 37 weeks' gestation. The primary outcome was simple or complex (i.e. involving bowel atresia, volvulus, perforation or necrosis) gastroschisis at birth. Fetal biometry (abdominal circumference and estimated fetal weight), the occurrence of polyhydramnios, intra- and extra-abdominal bowel diameters and the pulsatility index (PI) of the superior mesenteric artery (SMA) were assessed. Linear mixed modeling was used to compare the individual trajectories of cases with simple and those with complex gastroschisis, and logistic regression analysis was used to estimate the strength of association between the ultrasound parameters and outcome.
Results: Of 104 pregnancies with isolated fetal gastroschisis included, four ended in intrauterine death. Eighty-one (81%) liveborn infants with simple and 19 (19%) with complex gastroschisis were included in the analysis. We found no relationship between fetal biometric variables and complex gastroschisis. The SMA-PI was significantly lower in fetuses with gastroschisis than in healthy controls, but did not differentiate between simple and complex gastroschisis. Both intra- and extra-abdominal bowel diameters were larger in cases with complex, compared to those with simple, gastroschisis (P < 0.001 and P < 0.005, respectively). The presence of intra-abdominal bowel diameter ≥ 97.7 th percentile on at least three occasions, not necessarily on successive examinations, was associated with an increased risk of the fetus having complex gastroschisis (relative risk, 1.56 (95% CI, 1.02-2.10); P = 0.006; positive predictive value, 50.0%; negative predictive value, 81.4%).
Conclusions: This large prospective longitudinal study found that intra-abdominal bowel dilatation when present repeatedly during fetal development can differentiate between simple and complex gastroschisis; however, the positive predictive value is low, and therefore the clinical usefulness of this marker is limited. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
(© 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.)
Databáze: MEDLINE
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