March/April - West Virginia State Medical Association

Scientific Article |
Figures 3 and 4.
Table 1. Overall neonatal outcomes
Mean gestational age at diagnosis
18 weeks
Mean gestational age at delivery
35 weeks
Mean birth weight.
2384 grams
*Treatment of Gastrochisis
Silo 9
Primary repair 9
Complication of Gastrochisis
Bowel perforation 1
Intestinal atresia 1
Bowel necrosis 2
Neonatal death 4
*1 patient omitted since no repair done due to auto infarction of bowel
Table 2. Secondary Outcomes
Mean number of days on ventilator
Mean number of days to feeding
Mean length of hospital stay
7 days
14 days
44 days
obstetric ultrasounds. The second
examiner is a RDMC (Registered
diagnostic Medical sonographer)
ultrasonographer who has also
received specialized training in
high-risk obstetric ultrasounds. Both
examiners were asked to review each
and every ultrasound performed
on these babies independently and
were blinded to the outcome of the
study so as to eliminate any biases.
In addition, these examiners were
unaware of the previous readings
of these scans. The sonograms were
assessed for fetal growth parameters,
amniotic fluid index, diameter of the
small bowel dilation and thickness
of both intra-abdominal as well as
extra-abdominal loops of bowel.
Observations were also made on
whether the stomach was dilated or
not and whether the sonographer felt
that the Gastrochisis was complex
based on the presence or absence of
bowel atresia. In addition, comments
were also made about any additional
findings including any anomalies.
The maximum bowel diameter
was measured from inner wall to
inner wall along the short views of
the bowel loop at the most dilated
segment of the extruded bowel,
as well as the intra-abdominal
bowel. The bowel wall thickness
was measured from the outer wall
to the inner wall of the thickest
portion of the small bowel. (Figure
3 and 4) Delta dilation was also
calculated as final bowel dilation
minus the baseline bowel dilation
(taken from the first ultrasound
readings). The individual parameters
were compared for the same study
between the two examiners, and
there was a 100% concurrence
in the reading. The ultrasounds
were performed using highresolution
transducer with MHz
ranging between 2.5-5 MHz. The
equipment used was an Acuson
and GE high-resolution scanner.
The data was analyzed using a
statistical package using Statistical
Software (SAS Institute, Inc.,
Cary, NC). P values below 0.05
were considered as significant.
Results
A total of 25 cases were identified
during the time frame involved.
Six cases were excluded from the
analysis because of incomplete data,
including transfer of 3 babies thus
leaving 19 infants for this review. We
did not find any intrauterine deaths.
The mean age of the mothers was
20 years, the mean gestational age
at diagnosis was 18 weeks with a
range of 15 -20 weeks and the modal
parity was gravida 1. Each patient
had an average of 5 ultrasound scans
during their pregnancy. In 97% of
cases the last ultrasound was within
2 weeks of delivery. The other 3%
had their scan within the last 3
weeks prior to delivery. The mean
gestational age at delivery was 35
weeks (range 34 -38 weeks). Sixty
eight percent of babies were born
vaginally and 32 % were delivered
via C-section, most commonly due
to non-reassuring fetal heart rate
tracing and failure of progress. Eight
were induced; nine went into preterm
labor or had premature preterm
rupture of membranes. Forty two
percent were female fetuses and
58% were male fetuses, showing a
slightly greater male predominance.
Sixty three percent were found to
have intrauterine growth restriction
24 West Virginia Medical Journal