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Bowel dilation as a predictor of adverse outcome in isolated fetal gastroschisis
Author(s) -
Garcia L.,
Brizot M.,
Liao A.,
Silva M. M.,
Tannuri A. C.,
Zugaib M.
Publication year - 2010
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.2596
Subject(s) - gastroschisis , medicine , short bowel syndrome , fetus , neonatology , dilation (metric space) , obstetrics , pregnancy , biology , parenteral nutrition , genetics , mathematics , combinatorics
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. Copyright © 2010 John Wiley & Sons, Ltd.