Gastroschisis: can antenatal ultrasound predict infant outcomes?
Pryde, P.G.; Bardicef, M.; Treadwell, M.C.; Klein, M.; Isada, N.B.; Evans, M.I.
Obstetrics and Gynecology 84(4): 505-510
1994
ISSN/ISBN: 0029-7844 PMID: 8090384 Document Number: 428269
Objective: To test previously proposed but unproven antenatal ultrasound prognostic criteria in fetal gastroschisis. Methods: Thirty consecutive gastroschisis-affected pregnancies and their outcomes were reviewed retrospectively. Data were tabulated by review of antenatal ultrasound videotapes, with blinded comparison to indicators of short- and long-term infant outcomes obtained from the medical records. Criteria of previous reports were applied to these data, focusing on their ability to prognosticate effectively. Results: Applying a criterion of 10 mm bowel dilatation proved minimally useful in prognosticating infant outcomes. However, a stricter 17-mm criterion for clinically important bowel dilatation provided prognostic information, with remarkable improvement in specificity (75 versus 37%) and positive predictive value (55 versus 37%) for infant morbidity, with comparatively little loss of sensitivity (71 versus 85%). Conclusions: Bowel dilated more than 17 mm on antenatal ultrasound appears to be associated with increased short- and long-term infant morbidity. Whether this finding warrants obstetric intervention in the preterm gastroschisis-affected pregnancy with substantial bowel dilatation remains to be determined.