Accuracy of antenatal ultrasound signs in predicting the risk for bowel atresia in patients with gastroschisis

作者：Raia Barjat Tiphaine^*; Stadler Amandine; Varlet Marie Noelle; Fanget Cecile; Noblot Edouard; Prieur Fabienne; Chauleur Celine; Varlet Francois

来源：European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016, 203: 116-120.

DOI：10.1016/j.ejogrb.2016.05.045

• Gastroschisis
• Ultrasound
• Bowel atresia

Objective: Evaluate accuracy of prenatal ultrasound findings in predicting the risk of bowel atresia in patients with gastroschisis.
Methods: A retrospective study was conducted on 18 fetuses with a prenatal diagnostic of gastroschisis treated at University hospital of Saint Etienne France between 2002 and 2012. Ultrasound abnormalities were used to classify them into three groups: no ultrasound abnormality (n = 4), oligohydramnios (n = 9), intra-abdominal bowel dilatation >= 20.5 mm (n = 5). Postnatal outcomes were compared between groups. The threshold value of 20.5 mm for the prediction of atresia was determined through the receiver operator characteristics curve.
Results: In the group with oligohydramnios, intra uterine growth restriction were significantly more frequent (p = 0.015) and three newborns had serositis including two with secondary complications after the initial surgery. In the group with major intra-abdominal bowel dilatation, all had a narrow defect <10 mm significantly more than other fetuses (p = 0.002). Intra-abdominal bowel dilatation reaching 20.5 mm started at a mean gestational age significantly lower than that of the other fetuses (23.3 versus 29.7 weeks p = 0.02). On the five fetuses presented intra-abdominal bowel dilatation >= 20.5 mm, four showed atresia and no other newborn has this complication (p = 0.0016). The threshold value of 20.5 mm has a sensitivity of 100% and a specificity of 92.9%. The area under the curve was equal to 96.4%.
Conclusion: Intra-abdominal bowel dilatation >= 20.5 mm seems to be associated with the risk of postnatal atresia. MRI could help to clarify a complicated or uncertain ultrasound aspect.

• 出版日期2016-8