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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Ultrasound markers for prediction of complex gastroschisis and adverse outcome: longitudinal prospective nationwide cohort study
Ultrasound in Obstetrics and Gynecology, Volume 55, No. 6, Year 2020
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Description
Objectives: To identify antenatal ultrasound markers that can differentiate between simple and complex gastroschisis and assess their predictive value. Methods: This was a prospective nationwide study of pregnancies with isolated fetal gastroschisis that underwent serial longitudinal ultrasound examination at regular specified intervals between 20 and 37 weeks' gestation. The primary outcome was simple or complex (i.e. involving bowel atresia, volvulus, perforation or necrosis) gastroschisis at birth. Fetal biometry (abdominal circumference and estimated fetal weight), the occurrence of polyhydramnios, intra- and extra-abdominal bowel diameters and the pulsatility index (PI) of the superior mesenteric artery (SMA) were assessed. Linear mixed modeling was used to compare the individual trajectories of cases with simple and those with complex gastroschisis, and logistic regression analysis was used to estimate the strength of association between the ultrasound parameters and outcome. Results: Of 104 pregnancies with isolated fetal gastroschisis included, four ended in intrauterine death. Eighty-one (81%) liveborn infants with simple and 19 (19%) with complex gastroschisis were included in the analysis. We found no relationship between fetal biometric variables and complex gastroschisis. The SMA-PI was significantly lower in fetuses with gastroschisis than in healthy controls, but did not differentiate between simple and complex gastroschisis. Both intra- and extra-abdominal bowel diameters were larger in cases with complex, compared to those with simple, gastroschisis (P < 0.001 and P < 0.005, respectively). The presence of intra-abdominal bowel diameter ≥ 97.7th percentile on at least three occasions, not necessarily on successive examinations, was associated with an increased risk of the fetus having complex gastroschisis (relative risk, 1.56 (95% CI, 1.02–2.10); P = 0.006; positive predictive value, 50.0%; negative predictive value, 81.4%). Conclusions: This large prospective longitudinal study found that intra-abdominal bowel dilatation when present repeatedly during fetal development can differentiate between simple and complex gastroschisis; however, the positive predictive value is low, and therefore the clinical usefulness of this marker is limited. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC7318303/bin/UOG-55-776-s001.docx
Authors & Co-Authors
Lap, Chiara C.
Netherlands, Utrecht
University Medical Center Utrecht
Pistorius, Lourens Rasmus
South Africa, Stellenbosch
Stellenbosch University
Mulder, Eduard J.H.
Netherlands, Utrecht
University Medical Center Utrecht
Aliasi, Moska
Netherlands, Utrecht
University Medical Center Utrecht
Kramer, William L.M.
Netherlands, Utrecht
University Medical Center Utrecht
Bilardo, Caterina
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Netherlands, Groningen
Universitair Medisch Centrum Groningen
Cohen-Overbeek, Titia E.
Netherlands, Rotterdam
Erasmus Mc Sophia Children’s Hospital
Pajkrt, Eva
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Tibboel, Dick
Netherlands, Rotterdam
Erasmus Mc Sophia Children’s Hospital
Wijnen, René M.H.
Netherlands, Rotterdam
Erasmus Mc Sophia Children’s Hospital
Visser, Gerard H.A.
Netherlands, Utrecht
University Medical Center Utrecht
Manten, Gwendolyn T.R.
Netherlands, Utrecht
University Medical Center Utrecht
Netherlands, Zwolle
Isala Women and Children's Hospital
Bax, C. J.
Unknown Affiliation
van Baren, Robertine
Unknown Affiliation
Brouwers, Hens A.A.
Unknown Affiliation
Dijk, Peter H.
Unknown Affiliation
van Kaam, Anton H.
Unknown Affiliation
Koopman-Esseboom, Corine M.
Unknown Affiliation
Sikkel, E.
Unknown Affiliation
Haak, Monique C.
Unknown Affiliation
van Heijst, Arno F.
Unknown Affiliation
van der Hoeven, A. F.
Unknown Affiliation
Van Heurn, L. W.Ernst
Unknown Affiliation
Sleeboom, Christien
Unknown Affiliation
Van Weissenbruch, Mirjam M.
Unknown Affiliation
Willekes, Christine
Unknown Affiliation
Statistics
Citations: 26
Authors: 26
Affiliations: 6
Identifiers
Doi:
10.1002/uog.21888
ISSN:
09607692
e-ISSN:
14690705
Research Areas
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative