[en] OBJECTIVES: To assess the relevance and the quality of gastroschisis's care in a mid level referral centre. METHOD: A retrospective analysis was performed for infants diagnosed or born with gastroschisis between 1992 and 2003 at the Citadelle hospital, Department of Obstetrics and Gynaecology, University of Liege. RESULTS: Twenty-four cases of gastroschisis were identified. For 22 of them (92%) antenatal sonographic diagnosis was performed at a mean gestational age of 23 weeks. Antenatal diagnosis did not allow to identify additional malformation or chromosomal anomaly. Postnatal diagnosis allows to identify 3 infants with minor cardiac anomalies without functional consequence and one X fragile syndrome. One pregnancy was electively terminated at 24 weeks and one late intrauterine death was reported at 35 weeks. Bowel atresia, stenosis or ischemia were present at birth for 8 cases (33%). Out of 24 cases 22 were live born. 10 infants out of 22 (45%) underwent uncomplicated primary surgical repair. Three infants out of 22 (14%) underwent delayed closure without complications. Nine infants out 22 (41%) underwent multiple surgery (2 to 6). In this group all had postnatal complications, some with multisystem complications, including 3 deaths, 6 with infectious complications, 5 with gastrointestinal complications and 2 with genitourinary or haematological complications. Hospital stay range from 19 to 378 days (median, 51 days). Length of stay and time to full enteral feeding were longer if oligohydramnios or sonographic signs of intestinal damage were found. Among infants born before 35 weeks, only those with intestinal damage at birth had length of stay or time to full enteral feeding longer. Out of 22 live born infants 19 survived (86%) after one year. Survival rate without handicap due to gastroschisis is 84%. CONCLUSION: Sonographic examination is a valid method for prenatal diagnosis and surveillance. Our survival rate agrees with recent data in the literature. It has to be noticed that hospital stay is lengthy and complications are frequent. The most important prognostic factor is the condition of the bowel at birth and there is no antenatal means to predict severe damage.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Capelle, Xavier ; Centre Hospitalier Universitaire de Liège - CHU > Gynécologie-Obstétrique
Schaaps, Jean-Pierre ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Embryologie
Foidart, Jean-Michel ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie - Obstétrique
Language :
French
Title :
Gestion antenatale et issue postnatale des foetus atteints de laparoschisis
Alternative titles :
[en] Prenatal Care and Postnatal Outcome for Fetuses with Laparoschisis
Publication date :
September 2007
Journal title :
Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
Torfs C.P., Velie E.M., Oechsli F.W., et al. A population based study of gastroschisis: demographic, pregnancy and lifestyle factors. Teratology 50 (1994) 44-53
Luton M., De Lagausie P., Guibourdenche J., et al. Prognostic factors of prenatally diagnosed gastroschisis. Fetal Diagn. Ther. 12 (1997) 7-14
De Vries P.A. The pathogenesiss of gastroschisis and omphalocele. J. Pediatr. Surg. 15 (1980) 245-251
Tibboel D., Raine P., McNee A., et al. Developemental aspects of gastroshisis. J. Pediatr. Surg. 21 (1986) 865-869
Hoyme H.E., Higginbottom M.C., and Jones K.L. The vascular pathogenesis of gastroschisis: intrauterine interruption of the omphalomesenteric artery. J. Pediatr. 98 (1981) 228-231
Drongowski R.A., Smith R.K., Coran A.G., et al. Contribution of demographic and environemental factors to the etiology of gastroschisis: a hypothesis. Fetal diagn. and therap. 6 (1991) 14-27
Dixon J.C., Penman D.M., and Soothill P.W. The influence of bowel atresia in gastroschisis on fetal growth, cardiotocograph abnormalities and amniotic fluid staining. Brit J Obs Gyn 107 (2000) 472-475
Tibboel D., Raine P., McNee A., et al. Developemental aspects of gastroshisis. J. Pediatr. Surg. 21 (1986) 865-869
Langer J.C., Longaker M.T., Crombleholme T.M., et al. Etiology of intestinal damage in gastroschisis.1 : Effects of amniotic exposure and bowel constriction in a fetal lamb model. J. Pediatr. Surg. 24 (1989) 992-997
Kluck P., Tibboel D., Van Der Kamp A.W.M., et al. The effect of fetal urine on the developpement in gastroschisis. J. Pediatr. Surg. 18 (1983) 47-50
Aktüg T., Ucan B., Olguner M., et al. Amnio-allantoic fluid exchange for prevention of intestinal damage in gastroschisis II: Effects of exchange by using two differents solutions. Eur. J. Pediatr. Surg. 8 (1998) 308-311
Aktüg T., Ucan B., Olguner M., et al. Amnio-allantoic fluid exchange for prevention of intestinal damage in gastroschisis. III: Determination of the waste products removed by exchange. Eur. J. Pediatr. Surg. 8 (1998) 326-328
Api A., Olguner M., Hakgüder G., et al. Intestinal damage in gastroschisis correlates with the concentration of intraamniotic meconium. J. Pediatr. Surg. 36 (2001) 1811-1815
Akgür F.M., Özdemir T., Olguner M., et al. An experimental study investitating the effects of intraperitoneal human neonatal urine and meconium on rat intestines. Res. Exp. Med. (Berl.) 198 (1998) 207-213
Morrison J.J., Klein N., Chitty L., et al. Intra-amniotic inflammation in human gastroschisis: a possible aetiology of postnatal bowel dysfunction. Br. J. Obstet. Gynaecol. 105 (1998) 1200-1204
Mahieu-Caputo D., Muller F., Jouvet P.H., et al. Amniotic fluid B endorphin : a prognostic marker for gastroschisis?. J. Pediatr. Surg. 37 (2002) 1602-1606
Luton D., De Lagausie P., Guibourdenche J., et al. Pognostic factors of prenatally diagnosed gastrschisis. Fetal Diagn. Ther. 12 (1997) 7-14
Stoll C., Alembik Y., Dott B., et al. Risk factors in abdominal wall defects (omphalocele and gastroschisis): a study in a serie of 265,858 consecutive birth. Ann. Genet. (2001) 201-208
Barrisic I., Clementi M., Häusler M., et al. Evalution of prenatal diagnosis of fetal abdominal wall defects by 19 European registries. Ultrasound Obstet. Gynecol. 18 (2001) 309-316
Poulain P., Milon J., Frémont B., et al. Remarks about the prognosis in case of antenatal diagnosis of gastroschisis. Eur. J. Obstet. Gynecol. Reprod. Biol. (1994) 185-190
Robinson J.N., and Abuhamad A.Z. Abdominal wall and umbilical cord anomalies. Clin. Perinatol. 27 (2000) 947-978
Langer J.C., Khanna J., Caco C., et al. Prenatal diagnosis of gastroschisis: development of objective sonographic criteria for predicting outcome. Obstet. Gynecol. 81 (1993) 53-56
Luton M., De Lagausie P., Guibourdenche J., et al. Prognostic factors of prenatally diagnosed gastroschisis. Fetal Diagn. Ther. 12 (1997) 7-14
Pryde P., Bardicef M., Treadwell M.C., et al. Gastroschisis: can antenatal ultrasound predict outcome?. Obstet. Gynecol. 84 (1994) 505-509
Brun M., Grignon A., Guibaud L., et al. Gastroschisis: are prenatal ultrasonographic findings usefull for assessing the prognosis?. Pediatr. Radiol. 26 (1996) 723-726
Aina-Mumuney A.J., Fisher A.C., Blakemore K.J., et al. A dilated fetal stomach predicts a complicated postnatal course in case of prenatally diagnosed gastroschisis. Am. J. Obstet. Gynecol. 190 (2004) 1326-1330
Abuhamad A.Z., Mari G., Cortina R.M., et al. Superior mesenteric artery doppler velocimetry and ultrasonographic assessment of fetal bowel: a prospective longitudinal study. Am. J. Obstet. Gynecol. 176 (1997) 985-990
Luton D., Guibourdenche J., Vuillard E., et al. Prenatal management of gastroschisis : the place of the amnioexchange procedure. Clin. Perinatol. 30 (2003) 551-572
Puligandla S.P., Janvier A., Laberge J.M., et al. The significance of intrauterine growth restriction is different from prematurity for the outcome of infants with gastroschisis. J. Pediatr. Surg. 39 (2004) 1200-1204
Caroll S.G., Ping-yi K., Kyle M.P., et al. Fetal protein loss in gastroschisis as an explanation of associated morbidity. Am. J. Obstet. Gynecol. 184 (2001) 1297-1301
Dommergues M., Ansker Y., Aubry M.C., et al. Serial transabdominal amnioinfusion in the management of gastroschisis with severe olygohydramnios. J. Pediatr. Surg. 31 (1996) 1297-1299
Sapin E., Mahieu D., Borgnon J., et al. Transabdominal amnioinfusion to avoid fetal demise and intestinal damage in fetuses with gastroschisis and severe oligohydramnios. J. Pediatr. Surg. 35 (2000) 598-600
Aktug T., Demir N., Akgur F.M., et al. Pretreatment of gastroschisis with transabdominal amniotic fluid exchange. Obstet. Gynecol. 91 (1998) 821-823
Moir C.R., Ramsey P.S., Ogburn P.L., et al. A prospective trial of elective preterm delivery for fetal gastroschisis. Am. J. Perinatol. 21 (2004) 289-294
Driver C.P., Bruce J., Bianchi A., et al. The contemporary outcome of gastroschisis. J. Pediatr. Surg. 35 (2000) 1719-1723
Huang J., Kurkchubasche A.G., Luks F.I., et al. Benefits of term delivery in infants with antenatally diagnosed gastroschisis. Obstet. Gynecol. 100 (2002) 695-699
Segel S.Y., Marder S.J., Parry S., et al. Fetal abdominal wall defects and mode of delivery : A systematic review. ACOG 98 (2001) 867-873
Babcook C.J., Hedrick M.H., Goldstein R.B., et al. Gastroschisis: can the sonography of the fetal bowel accurately predict postnatal outcome?. J. Ultrasound Med. 13 (1994) 701-706
Molik K.A., Gingalewski C.A., West F.J., et al. Gastroschisis: a plea for risk categorization. J. Pediatr. Surg. 36 (2001) 51-55
Burk L., Volumenie J.L., de Lagausie P., et al. Amniotic fluid inflammatory proteins and digestive compounds profile in fetuses with gastroschisis undergoing amnioexchange. BJOG 111 (2004) 292-297
Brantberg A., Blaas H.G.K., Salvesen K.A., et al. Surveillance and outcome of fetuses with gastroschisis. Ultrasound Obstet. Gynecol. 23 (2004) 4-13