Intrauterine Growth Patterns in Fetal Gastroschisis

ABSTRACT

The objective of this study was to evaluate patterns of intrauterine growth in fetal gastroschisis. This was a retrospective review of prenatally diagnosed cases of fetal gastroschisis delivered at the University of North Carolina Hospital from January 2000 to January 2007. Fetal growth (biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight) and amniotic fluid volume were evaluated by gestational age. Gastroschisis was diagnosed in 83 pregnancies; outcomes were available in 71 fetuses. The mean gestational age at diagnosis was 17 weeks and 1 day. The mean gestational age at delivery was 35 weeks and 4 days. Mean birth weight was 2306 g. As early as the second trimester, all morphometric measures demonstrated impaired in utero growth, with growth curves shifted to the right of the 50th percentile when compared with a standard population. Estimated fetal weight below the 10th percentile was suspected in 23% of pregnancies, and birth weight at less than the 10th percentile occurred in 47% of neonates. Amniotic fluid volumes remained stable throughout gestation. Fetuses with gastroschisis display impaired intrauterine growth, which is noted in the midsecond trimester of pregnancy and does not appear to progress throughout gestation.

KEYWORDS

Gastroschisis - intrauterine growth restriction - prenatal diagnosis - ultrasound

REFERENCES

• 1 Eurenius K, Axelsson O. Outcome for fetuses with abdominal wall defects detected by routine second trimester ultrasound.  Acta Obstet Gynecol Scand. 1994;  73 25-29
• 2 Calzolari E, Bianchi F, Dolk H, Milan M. EUROCAT Working Group . Omphalocele and gastroschisis in Europe: a survey of 3 million births 1980–1990.  Am J Med Genet. 1995;  58 187-194
• 3 Laughon M, Meyer R, Bose C et al.. Rising birth prevalence of gastroschisis.  J Perinatol. 2003;  23 291-293
• 4 Curry J I, McKinney P, Thornton J G, Stringer M D. The aetiology of gastroschisis.  BJOG. 2000;  107 1339-1346
• 5 Luton D, Guibourdenche J, Vuillard E, Bruner J, de Lagausie P. Prenatal management of gastroschisis: the place of the amnioexchange procedure.  Clin Perinatol. 2003;  30 551-572, viii
• 6 Emusu D, Salihu H M, Aliyu Z Y, Pierre-Louis B J, Druschel C M, Kirby R S. Gastroschisis, low maternal age, and fetal morbidity outcomes.  Birth Defects Res A Clin Mol Teratol. 2005;  73 649-654
• 7 Lam P K, Torfs C P, Brand R J. A low pregnancy body mass index is a risk factor for an offspring with gastroschisis.  Epidemiology. 1999;  10 717-721
• 8 Torfs C P, Velie E M, Oechsli F W, Bateson T F, Curry C J. A population-based study of gastroschisis: demographic, pregnancy, and lifestyle risk factors.  Teratology. 1994;  50 44-53
• 9 David A L, Tan A, Curry J. Gastroschisis: sonographic diagnosis, associations, management and outcome.  Prenat Diagn. 2008;  28 633-644
• 10 Cullen M T, Green J, Whetham J, Salafia C, Gabrielli S, Hobbins J C. Transvaginal ultrasonographic detection of congenital anomalies in the first trimester.  Am J Obstet Gynecol. 1990;  163 466-476
• 11 Snyder C L. Outcome analysis for gastroschisis.  J Pediatr Surg. 1999;  34 1253-1256
• 12 Abdullah F, Arnold M A, Nabaweesi R et al.. Gastroschisis in the United States 1988–2003: analysis and risk categorization of 4344 patients.  J Perinatol. 2007;  27 50-55
• 13 Burge D M, Ade-Ajayi N. Adverse outcome after prenatal diagnosis of gastroschisis: the role of fetal monitoring.  J Pediatr Surg. 1997;  32 441-444
• 14 Adair C D, Rosnes J, Frye A H, Burrus D R, Nelson L H, Veille J C. The role of antepartum surveillance in the management of gastroschisis.  Int J Gynaecol Obstet. 1996;  52 141-144
• 15 Crawford R A, Ryan G, Wright V M, Rodeck C H. The importance of serial biophysical assessment of fetal wellbeing in gastroschisis.  Br J Obstet Gynaecol. 1992;  99 899-902
• 16 Fischer J D, Chun K, Moores D C, Andrews H G. Gastroschisis: a simple technique for staged silo closure.  J Pediatr Surg. 1995;  30 1169-1171
• 17 Netta D A, Wilson R D, Visintainer P et al.. Gastroschisis: growth patterns and a proposed prenatal surveillance protocol.  Fetal Diagn Ther. 2007;  22 352-357
• 18 South A P, Marshall D D, Bose C L, Laughon M M. Growth and neurodevelopment at 16 to 24 months of age for infants born with gastroschisis.  J Perinatol. 2008;  28 702-706
• 19 Hadlock F P, Harrist R B, Carpenter R J, Deter R L, Park S K. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements.  Radiology. 1984;  150 535-540
• 20 Lessoway V A, Schulzer M, Wittmann B K, Gagnon F A, Wilson R D. Ultrasound fetal biometry charts for a North American Caucasian population.  J Clin Ultrasound. 1998;  26 433-453
• 21 Wahl R. Nutrition in the adolescent.  Pediatr Ann. 1999;  28 107-111
• 22 Fries M H, Filly R A, Callen P W, Goldstein R B, Goldberg J D, Golbus M S. Growth retardation in prenatally diagnosed cases of gastroschisis.  J Ultrasound Med. 1993;  12 583-588
• 23 Carroll S G, Kuo P Y, Kyle P M, Soothill P W. Fetal protein loss in gastroschisis as an explanation of associated morbidity.  Am J Obstet Gynecol. 2001;  184 1297-1301
• 24 Dixon J C, Penman D M, Soothill P W. The influence of bowel atresia in gastroschisis on fetal growth, cardiotocograph abnormalities and amniotic fluid staining.  BJOG. 2000;  107 472-475
• 25 Brantberg A, Blaas H G, Salvesen K A, Haugen S E, Eik-Nes S H. Surveillance and outcome of fetuses with gastroschisis.  Ultrasound Obstet Gynecol. 2004;  23 4-13
• 26 Santiago-Munoz P C, McIntire D D, Barber R G, Megison S M, Twickler D M, Dashe J S. Outcomes of pregnancies with fetal gastroschisis.  Obstet Gynecol. 2007;  110 663-668
• 27 Japaraj R P, Hockey R, Chan F Y. Gastroschisis: can prenatal sonography predict neonatal outcome?.  Ultrasound Obstet Gynecol. 2003;  21 329-333
• 28 Raynor B D, Richards D. Growth retardation in fetuses with gastroschisis.  J Ultrasound Med. 1997;  16 13-16
• 29 Russell Z, Destefano K, Smith S, Salishu H, Quintero R. How fetal weight be estimated in fetuses with gastroschisis? Abstract #170.  Am J Obstet Gynecol. 2008;  197 S59