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Adverse outcome after prenatal diagnosis of gastroschisis: The role of fetal monitoring

Adverse outcome after prenatal diagnosis of gastroschisis: The role of fetal monitoring,10.1016/S0022-3468(97)90601-1,Journal of Pediatric Surgery,D.

Adverse outcome after prenatal diagnosis of gastroschisis: The role of fetal monitoring   (Citations: 22)
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Fifty-seven fetuses with gastroschisis presented between 1982 and 1995 were studied by retrospective review of medical records. There were three late intrauterine deaths (IUD). Fetal distress, as determined by reduced fetal movements or abnormal cardiotopograph (CTG), was encountered in 23 of the 54 liveborn infants (43%), all of whom had delivery expedited either by emergency caesarean section (n = 19) or induction (n = 4). Six infants had abnormal neurological outcome: two died in the neonatal period of severe perinatal brain injury, neonatal fits were observed in four, two of whom developed cerebral palsy, and one died at the age of 7 years. All six of these infants had suffered fetal distress. If the three intrauterine deaths are included, 16% of all cases were associated with abnormal neurological outcome. The introduction of regular CTG monitoring from 32 weeks' gestation in 1990 increased the ability to detect fetal distress twofold. This resulted in a similar increase in obstetric intervention and an associated reduction in adverse neurological outcome. Pregnancies associated with gastroschisis should be considered at significant risk of fetal distress, which itself may culminate in late intrauterine death, neonatal death, or adverse neurological outcome. Careful, repeated fetal monitoring in the third trimester is indicated.
Journal: Journal of Pediatric Surgery - J PEDIAT SURG , vol. 32, no. 3, pp. 441-444, 1997
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    • ...Many studies have found an increased risk of IUFD associated with gastroschisis with a reported rate of between 10 and 15% [1, 11, 12]...

    Alice L. Mearset al. Antenatal bowel dilatation in gastroschisis: a bad sign?

    • ...Although the exact mechanism is still unknown, it is believed that the transmural loss of protein across the exposed bowel wall into the amniotic fluid may cause a nutritional drain on the fetus and, therefore, impair fetal growth [,...

    Tak Yuen Funget al. Gastroschisis Associated with an Intra-Abdominal Umbilical Vein Varix:...

    • ...Ultrasound has identified different patterns of abnormal fetal growth and classifies IUGR as either asymmetric or symmetric. Asymmetric IUGR is generally considered a nutritional compromise with normal head growth and decreased abdominal growth. Symmetric IUGR presents with decreased growth for both head and abdomen (using a clinical definition of <10th percentile) and generally suggests a more significant fetal pathology, including chromosomal, placental, and genetic abnormalities.The serial assessment of growth curves for fetuses with gastroschisis may allow the differentiation between growth changes due to gastroschisis as compared with additional risk factors which may be additive to the gastroschisis growth restricted background risk. The identification of additional growth abnormalities may allow a more directed fetal assessment (amniotic fluid index, biophysical profile, fetal arterial and venous Doppler evaluation) with possible decreases in perinatal morbidity and mortality [,,...

    Denise A. Nettaet al. Gastroschisis: Growth Patterns and a Proposed Prenatal Surveillance Pr...

    • ...Delivery by caesarean section has no advantage to normal vaginal route [95]...

    Kokila Lakhoo. Fetal counselling for congenital malformations

    • ...Outcomes for the traditional approach to gastroschisis have been summarized in several case series [5], [6], [7], [9] and [10]...
    • ...compromise of the lower abdomen, kidneys and legs with abdominal compartment syndrome; gut perforation; infection (septicemia and/or wound infection); abdominal scars; a cosmetically abnormal umbilicus; late surgery for gut adhesions or scar cosmesis; compromised nutrition; and adverse neurologic outcome [9], [10] and [11]...

    Mark W. Davieset al. Gastroschisis: Ward Reduction Compared With Traditional Reduction Unde...

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