Antenatal fetal surveillance in pregnancies complicated by fetal gastroschisis

Craig Towers, Margaret H. Carr

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: The purpose of this study was to determine if antenatal fetal surveillance should be considered in pregnancies complicated by fetal gastroschisis, and if so, what gestational age should testing begin. Study Design: During an 18-year period, all pregnancies delivered of a newborn that had gastroschisis were identified. Numerous data parameters were collected, including gestational age at delivery, birthweight, indication for delivery, antenatal testing results if performed, and neonatal outcome. Fetal compromise was defined as stillbirth or moderate to severe arterial cord blood gas acidosis at the time of delivery (pH < 7.10). Results: During the study period, 84 pregnancies complicated by fetal gastroschisis were delivered from 117,564 gestations. Antenatal testing was performed in 58 cases (69%). Of the 26 (31%) without antenatal testing, 17 had an antenatal diagnosis of gastroschisis and in 9, the diagnosis was made on the day of delivery. In the 17 with an antenatal diagnosis, there were 2 stillbirths (294/7 and 313/7 weeks' gestation) and 1 was delivered with a moderate to severe arterial cord blood gas acidosis at 295/7 weeks' gestation. An additional case of moderate to severe arterial cord blood gas acidosis occurred in the 9 cases where the diagnosis was made on the day of delivery. Of the 58 pregnancies with antenatal surveillance, there were no stillbirths and no cases with a moderate to severe arterial cord blood gas acidosis. Of these 58 cases, 22 (38%) were delivered based on an abnormal testing result. Of the 84 total cases, 32 (38%) had birthweights < 10th percentile, and of these, 16 (19%) had birthweights < 3rd percentile. Conclusion: Based on these data, antenatal fetal surveillance may be warranted in pregnancies complicated by fetal gastroschisis beginning at a gestational age of 28 to 29 weeks. Fetal testing between the thresholds of viability up to 28 weeks' gestation would be controversial.

Original languageEnglish (US)
Pages (from-to)686.e1-686.e5
JournalAmerican Journal of Obstetrics and Gynecology
Volume198
Issue number6
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

Fingerprint

Gastroschisis
Pregnancy
Acidosis
Fetal Blood
Stillbirth
Gases
Gestational Age
Prenatal Diagnosis

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

Antenatal fetal surveillance in pregnancies complicated by fetal gastroschisis. / Towers, Craig; Carr, Margaret H.

In: American Journal of Obstetrics and Gynecology, Vol. 198, No. 6, 01.01.2008, p. 686.e1-686.e5.

Research output: Contribution to journalArticle

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abstract = "Objective: The purpose of this study was to determine if antenatal fetal surveillance should be considered in pregnancies complicated by fetal gastroschisis, and if so, what gestational age should testing begin. Study Design: During an 18-year period, all pregnancies delivered of a newborn that had gastroschisis were identified. Numerous data parameters were collected, including gestational age at delivery, birthweight, indication for delivery, antenatal testing results if performed, and neonatal outcome. Fetal compromise was defined as stillbirth or moderate to severe arterial cord blood gas acidosis at the time of delivery (pH < 7.10). Results: During the study period, 84 pregnancies complicated by fetal gastroschisis were delivered from 117,564 gestations. Antenatal testing was performed in 58 cases (69{\%}). Of the 26 (31{\%}) without antenatal testing, 17 had an antenatal diagnosis of gastroschisis and in 9, the diagnosis was made on the day of delivery. In the 17 with an antenatal diagnosis, there were 2 stillbirths (294/7 and 313/7 weeks' gestation) and 1 was delivered with a moderate to severe arterial cord blood gas acidosis at 295/7 weeks' gestation. An additional case of moderate to severe arterial cord blood gas acidosis occurred in the 9 cases where the diagnosis was made on the day of delivery. Of the 58 pregnancies with antenatal surveillance, there were no stillbirths and no cases with a moderate to severe arterial cord blood gas acidosis. Of these 58 cases, 22 (38{\%}) were delivered based on an abnormal testing result. Of the 84 total cases, 32 (38{\%}) had birthweights < 10th percentile, and of these, 16 (19{\%}) had birthweights < 3rd percentile. Conclusion: Based on these data, antenatal fetal surveillance may be warranted in pregnancies complicated by fetal gastroschisis beginning at a gestational age of 28 to 29 weeks. Fetal testing between the thresholds of viability up to 28 weeks' gestation would be controversial.",
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