L. Joyeux1, O. O. Olutoye1, T. C. Lee1, A. King1, M. Sanz Cortez1, L. H. Hollier1, N. Ahmed1, M. A. Belfort1, S. G. Keswani1 1Baylor College Of Medicine, Texas Children’s Fetal Center, Texas Children’s Hospital, Houston, TX, USA
Introduction:
Gastroschisis (GS) is the most common congenital abdominal wall defect, which when complex (bowel stenosis, atresia, necrosis, perforation or volvulus and/or length of stay greater than 60 days), is associated with significant long-term sequela and mortality. Intervening in the fetal period to protect the bowel from the amniotic fluid or to relieve lymphovascular constriction has the potential to improve outcomes in patients with complex GS. Intraabdominal bowel dilation (IABD) has been shown to be an accurate marker of GS severity. The purpose of this study was to determine if fetal intraabdominal dilation of ≥ 6 mm identifies complex GS patients that may benefit from in-utero intervention.
Methods:
Retrospective review of neonates with GS delivered at a single institution was performed from 2012-2017. A blinded maternal-fetal medicine specialist examined 20-25-week fetal ultrasounds of all patients and measured the largest inner-to-inner wall intraabdominal bowel diameter. Patients were clinically stratified as complex or simple GS. Sensitivity, specificity, positive predictive value (PPV), Negative Predictive value (NPV) and ROC curve of an IABD of ≥ 6 mm were analyzed, and ROC analysis was performed.
Results:
Seventy-six patients with GS were included in the study, of which 30 (39.5%) had complex GS. 6 (20%) of complex GS patients had an IABD ≥6mm at 20-25 weeks. In contrast, only 2 (4.2%) of patients with simple GS had IABD ≥6mm at the same gestational age. Analysis of these data resulted in a 20.0 % Sensitivity, 95.7% Specificity, 75.0% PPV, 65.2% NPV and 67.4% area under the ROC curve (Figure 1).
Conclusion:
The high specificity and PPV confirm that our 6-mm cutoff for IABD accurately predicts those complex GS patients who may benefit from fetal intervention while minimizing the operative risks for patients who have simple GS. Prenatal identification of those patients with complex GS may facilitate fetal intervention that may improve patient outcomes.
