Prenatal assessment of viscero-abdominal disproportion in fetuses with gastroschisis and its clinical significance

Abstract

Purpose - to present a method of prenatal assessment of viscero-abdominal disproportion in fetuses with gastroschisis during two-dimensional ultrasound examination, to compare prenatally determined indices with postnatal clinical data. Materials and methods. Extended measurements of the abdominal cavity and eventrated organs in 161 fetuses with gastroschisis were performed at different terms of pregnancy. Postnatal intraoperative data and general clinical outcomes were compared in 74 cases depending on the results of prenatal measurements: the presence and degree of pathological changes in the eventrated intestine, the degree of viscero-abdominal disproportion and type of surgical correction, presence of associated intestinal malformations and mortality. Results. A methodology for determining the index of viscero-abdominal disproportion in fetuses with gastroschisis and a working classification of its degrees was proposed. The disproportion was absent in the 2nd trimester in 80.5% of fetuses, and in the 3rd trimester only in 40.7%. During the 2nd trimester, the degree of VAD changed in 1.8% of cases, during the 3rd trimester in 11.1% of cases. Among the 55 fetuses examined in both the 2nd and 3rd trimesters, a change in the degree of VAD was registered in 78.2% of cases. Significant differences in postnatal clinical data were found in groups with absent, moderate and severe disproportion: no changes of the eventrated intestine were found in 50%, 34.1% and 7.1%, respectively, significant changes of the intestine were present in 12.5%, 36.4% and 50%, associated intestinal anomalies were diagnosed in 18.75%, 13.6% and 35.7%, primary correction with fascial closure was performed in 37.5%, 9.0% and 0%, staged repair with synthetic patch/silo and delayed abdominal wall closure in 0%, 20.5% and 57.1%. Mortality was 6.3%, 13.6% and 35.7%, respectively. Conclusions. A new method for assessing the congruence of the volumes of eventrated organs and abdominal cavity in fetuses with gastroschisis can provide important additional information for refining prenatal diagnosis, determining the severity of pathological process and predicting postnatal outcome. Prenatal evaluation of the degree of viscero-abdominal disproportion will allow to choose the correct management of pregnancy and labor, as well as to plan specialized care of the newborns. Key words: congenital malformations, prenatal diagnosis, anterior abdominal wall, gastroschisis, viscero-abdominal disproportion