March/April - West Virginia State Medical Association

Scientific Article |
Can Antenatal Ultrasounds Help Predict Postnatal
Outcomes in Babies Born with Gastrochisis?
The West Virginia Experience
Jabin Janoo, MD, FACOG
Assistant Professor, Department of Obstetrics and
Gynecology, WVU
Micheal Cunningham, MD
Associate Professor, Department of Radiology, WVU
Gerald R. Hobbs, PhD
Associate Professor of Statistics, WVU
Angela O’ Bringer, PhD
Assistant Professor, Department of Obstetrics and
Gynecology, WVU
Maria Merzouk, DO, FACOG
Assistant Professor, Department of Obstetrics and
Gynecology,WVU
Corresponding Author: Jabin Janoo, MD, FACOG,
Assistant Professor, Department of Obstetrics and
Gynecology, West Virginia University, P.O. Box 9186
Morgantown WV 26505 jajezfj@hotmail.com
Abstract
Objective: Gastrochisis is a
congenital condition resulting in significant
morbidity and mortality. Multiple studies
have been done to evaluate the value of
prognostic indicators with conflicting
results. The aim of this study was to
evaluate the role of ultrasound in this
condition at a single institution while
limiting the provider variables that may
affect neonatal outcome.
Methods: The antepartum charts of
expectant mothers of affected fetuses as
well as the neonatal hospital charts were
reviewed at length. The cases were
identified over a period of 4 years from
April 1998 to February 2002. In addition,
the archived photographs of ultrasounds
performed on these fetuses were also
reviewed and reread by two independent
providers who were blinded to the
outcome. Adverse neonatal outcome,
including death and time to feeding
(amongst many other variables) were
assessed against the different ultrasound
parameters including bowel thickness and
dilation.
Results: 25 patients were identified in
the stated time frame. Six cases had to be
dropped from the final analysis due to
incomplete data including the transfer of 3
babies. There were 4 neonatal deaths.
The mean birth weight was 2384 grams.
There was a significant association with
dilation and delta dilation (defined as the
difference in bowel dilation from the final
ultrasound from the baseline ultrasound
cutoff of 4 mm) and time to feeding, time
on ventilator and hospital stay. (P< 0.005).
Other ultrasound parameters were not
significantly correlated with neonatal
outcome.
Conclusion: Most ultrasound
parameters do not help prognosticate the
neonatal outcome in babies affected with
this condition except for dilation and delta
dilation, which are strong predictors of
morbidity in the post delivery period. This
information may be helpful to providers
and parents of affected fetuses.
Introduction
Gastrochisis is a congenital
malformation. It is an abnormality of
the fetal anterior abdominal wall in
which there is a full thickness defect,
usually to the right of the umbilical
cord insertion. (Figure 1 and 2). The
defect causes abdominal viscera to
herniate into the amniotic fluid. This
condition is generally not associated
with chromosomal anomalies
of the fetus although it may be
associated with other gastrointestinal
abnormalities. This is an important
differentiating feature between
Gastrochisis and omphalocele. In
addition fetuses with omphalocele
have the abdominal viscera
covered with a membranous sac.
The incidence of Gastrochisis
is estimated to be 1.36 per 10000
births. 1 The number of reported cases
has been increasing over the last
twenty years. 2 This is a reflection of
better diagnostic methodology, an
increase in the use of ultrasound as
well as a true increase in incidence.
Fetuses with Gastrochisis have
Figures 1 and 2.
a higher incidence of perinatal
mortality and morbidity compared
to unaffected fetuses. Neonatal
mortality rates of up to 7.5% 3 have
been reported and up to 12.5% of
affected fetuses will be stillbirths. 4
An important prognostic factor
in the outcome of these fetuses is
based on the condition of the bowel
at the time of birth. There has been
some suggestion in the literature that
the fetuses with Gastrochisis can be
divided into two groups based on
the presence or absence of intestinal
complications at the time of birth. 3
These defects can include bowel
atresia, bowel perforation, bowel
necrosis or volvulus. These two
groups have significant differences
in clinical outcomes including
length of hospital stay, post surgical
complications and mortality. If
it is possible to predict these two
22 West Virginia Medical Journal