Gastroschisis – can prenatal ultrasonography predict neonatal outcome?

Background:  Gastroschisis carries significant neonatal morbidity, and occasionally mortality. Previous studies looking at ways to prognosticate this condition by antenatal ultrasound have shown conflicting results. Small numbers limited the power of most previous studies. The current study is one of the largest so far reported.Purpose:  To evaluate the usefulness of prenatal ultrasonograpic parameters to predict neonatal outcome for gastroschisis.Methods:  The charts, photos, and videotapes of all babies with gastroschisis who were assessed during pregnancy at the Mater Mothers' Hospital, Brisbane over an 8.5‐year period (January 1993–May 2001) were reviewed. Bad neonatal outcome was defined as death, severe bowel complications (atresia, perforation, necrotic segments), need for multiple bowel operations, or a combination of these. Various ultrasonographic parameters assessed included: gestation at first diagnosis, maximum bowel diameter, maximum bowel thickness, presence of other anomalies, evidence of growth restriction, and polyhydramnios.Results:  Forty‐five patients met the entry criteria during the study period. Six neonates died, 12 had severe bowel complications, and 14 had a combination of the bad outcomes. Apart from polyhydramnios, none of the other ultrasound parameters were significantly associated with the bad outcomes. Polyhydramnios was most significantly associated with severe bowel complications (P < 0.001, Fisher’s exact test), with likelihood ratio of 11.7 (P = 0.001).Conclusion:  The current study show that most standard ultrasound parameters assessed antenatally in fetal gastroschisis were not significantly associated with neonatal outcome, except for polyhydramnios, which is strongly predictive of severe bowel complications in the neonatal period. This information is important both for parents and for health professionals managing pregnancies with fetal gastroschisis.