1980 archive gastroschisis

Transcription

Research
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OBSTETRICS
Metaanalysis of the prevalence of intrauterine fetal death
in gastroschisis
Andrew P. South, MD, MPH; Kevin M. Stutey, MD; Jareen Meinzen-Derr, PhD, MPH
OBJECTIVE: The objective of this study was to review the medical
literature that has reported the risk for intrauterine fetal death (IUFD) in
pregnancies with gastroschisis.
had a pooled prevalence of IUFD of 1.28 per 100 births at 36 weeks’
gestation. The prevalence did not appear to increase at >35 weeks’
gestation.
STUDY DESIGN: We systematically searched the literature to identify
all published studies of IUFD and gastroschisis through June 2011 that
were archived in MEDLINE, PubMed, or referenced in published
manuscripts. The MESH terms gastroschisis or abdominal wall defect
were used.
CONCLUSION: The overall incidence of IUFD in gastroschisis is
much lower than previously reported. The largest risk of IUFD
occurs before routine and elective early delivery would be acceptable.
Risk for IUFD should not be the primary indication for routine
elective preterm delivery in pregnancies that are affected by
gastroschisis.
RESULTS: Fifty-four articles were included in the metaanalysis. There
were 3276 pregnancies in the study and a pooled prevalence of IUFD
of 4.48 per 100. Those articles that included gestational age of IUFD
Key words: abdominal wall defect, fetal death, gastroschisis, IUFD,
stillbirth
Cite this article as: South AP, Stutey KM, Meinzen-Derr J. Metaanalysis of the prevalence of intrauterine fetal death in gastroschisis. Am J Obstet Gynecol
2013;209:114.e1-13.
G
astroschisis is an abdominal wall
defect of unclear cause and increasing incidence worldwide; current
estimates are near 5 per 10,000 births.1
There have been great improvements
in survival in this patient population
From the Divisions of Neonatology (Drs South
and Stutey) and Biostatistics and Epidemiology
(Dr Meinzen-Derr), Department of Pediatrics,
Cincinnati Children’s Hospital Medical Center,
University of Cincinnati College of Medicine,
Cincinnati, OH.
Received Jan. 30, 2013; revised April 2, 2013;
accepted April 24, 2013.
This study was supported by the Perinatal
Institute at Cincinnati Children’s Hospital
Medical Center, Cincinnati, OH.
The authors report no conflict of interest.
Presented at the annual meeting of the
Pediatric Academic Societies, Boston, MA,
April 28-May 1, 2012.
Reprints: Andrew P. South, MD, MPH,
3333 Burnet Ave., Cincinnati, OH 45229.
andrew.south@cchmc.org.
0002-9378/free
ª 2013 Mosby, Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ajog.2013.04.032
For Editors’ Commentary,
see Contents
because >95% of infants survive from
birth to initial hospital discharge.2
However, there remain many questions
about perinatal management and, in
particular, about the optimal gestational
age at delivery. Intrauterine fetal death
(IUFD) is more common in pregnancies
that are affected by congenital anomalies.
Among all major congenital anomalies,
2% of pregnancies result in stillbirth,3
which is much higher than the 0.6%
baseline rate in the general population.4,5
This higher risk of stillbirth results in a
higher frequency and level of antenatal
monitoring and, in some cases, elective
delivery at <39 weeks’ gestation.6 Decisions regarding obstetric management
must be based on accurate knowledge
of the risk for fetal death.
The mean age of spontaneous labor in
pregnancies that are affected by gastroschisis is between 36 and 37 weeks’
gestation,7 yet the average age of delivery
is approximately 1 week earlier. This
discrepancy leads to the conclusion that
infants with gastroschisis deliver early
either for fetal/maternal indications or
electively.8 Although some clinicians
advocate for early delivery to improve
114.e1 American Journal of Obstetrics & Gynecology AUGUST 2013
postnatal clinical outcomes (such as
earlier initiation of enteral feeds and
shorter hospitalization time), the literature does not document a consistent
benefit.9-11 Therefore, the primary
rationale for elective delivery before the
onset of labor may be the prevention of
IUFD.12
The reported incidence of IUFD in
pregnancies that are affected by gastroschisis is as high as 12.5%.13 Although
the cause for the increased risk of
IUFD is unknown, hypotheses include
umbilical cord compression after acute
intestinal dilation,14 oligohydramnios,15
cardiovascular compromise that is
related to high protein loss through the
defect and subsequent hypovolemia,16
and cytokine-mediated inflammation.17,18 Additionally, there is increased
risk for volvulus and vascular compromise that could lead to fetal death.19
Studies that have documented high
rates of IUFD are limited by small
numbers, and many were conducted at a
time when prenatal diagnosis of gastroschisis was uncommon. These studies
found that most IUFDs occurred late in
the third trimester. Obstetricians developed the practice of early elective delivery based on these studies. Additional
Obstetrics
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studies that have suggested lower rates of
IUFD are also limited by sample sizes
and evaluations of single institutions or
populations. Our own experience suggests a much lower rate of IUFD than
10-12%. The limitations of individual
studies compromise ascertainment of
the true incidence of IUFDs with
gastroschisis.
We present a metaanalysis to generate
a more accurate representation of the
prevalence of IUFD among infants with
prenatal diagnosis of gastroschisis. We
hypothesize that the prevalence of IUFD
is less than previously reported and that
the risk of IUFD does not vary with
gestational age.
M ATERIALS
AND
M ETHODS
We conducted a metaanalysis of the
published, English-language literature
that is related to gastroschisis.
Literature search
A systematic search was done independently by 2 of the authors (A.S., K.S.)
who reviewed the literature to identify
all published studies through June 2011
that were archived in MEDLINE and
PubMed or were referenced in published articles. The MESH terms gastroschisis or abdominal wall defect were
used. Abstracts were reviewed initially
and excluded based on predetermined
criteria that included non-English language, nonhuman subjects, or no relation to gastroschisis. The remaining
articles were selected for full text review,
which led to further exclusion of articles
that did not report the number of
IUFDs, case reports, studies with small
sample sizes (n <10), and datasets that
did not represent the total population
(eg, case series of live births with gastroschisis or if the total number of
pregnancies with gastroschisis was not
disclosed). When there were multiple
studies that used the same dataset, we
included only 1 article and prioritized
the article that reported the gestational
age of IUFD. If both articles reported
gestational age at IUFD, the article with
the larger number of infants was
included. The included articles were
divided into those with a stated gestational age at IUFD and those without.
Data extraction
Data regarding all reported pregnancies,
including termination of pregnancy,
were extracted independently from all
included studies by 2 authors (A.S.,
K.S.). Extracted data included gestational age at delivery, gestational age at
IUFD, country of origin, year the study
was published, presence of comorbidities in addition to gastroschisis, and
obstetric delivery plan. IUFD was
defined as an unplanned fetal death or
stillbirth at any gestational age. The
mean or median gestational age at delivery was extracted for each study. Early
delivery plan was defined as systematic
elective delivery at any predefined
gestational age, compared with awaiting
the onset of spontaneous labor or delivery because of maternal or fetal
indications.
Quality assessment
A scoring system that was based on a
previous metaanalysis was used to create
a grading scale for the articles.20 Studies
were independently graded (A.S., K.S.)
with the use of a standardized evaluation
form that had been developed for the
purpose of this metaanalysis. Each study
was assigned a grade of 1-5 according to
the quality of reporting of 5 factors.
Variables were chosen to represent the
factors that we believed to be essential
for contributing valid data (populationbased data, prospective data collection)
or essential for understanding results
(identified obstetric delivery plan, reported gestational age at birth, and reported gestational age at the time of
IUFD). Differences between reviewers’
grades were resolved by consensus
among all 3 authors. The quality markers
that were chosen for this study were
identified before the start of data
abstraction. The rate of IUFD was
compared among studies on the basis of
the assigned quality assessment scores.
Statistical analysis
The rate of IUFD was calculated for each
study with the number of IUFDs reported in the numerator and the number
of live births plus IUFDs in the denominator. Pregnancies that were terminated
electively were not included in the
Research
numerator or denominator, because
these pregnancies were considered not at
risk for an IUFD. A random-effects
model was used to aggregate individual
effect sizes to create a pooled prevalence
of IUFD. Random-effects models are
based on the assumption that the studies
that were selected for analysis are a
sample of all potential studies by incorporating between-study variability in the
overall pooled estimation.21 Pooled
prevalence estimates of IUFD with
95% confidence intervals were reported
from these models with the use of
the Der Simonian-Laird random-effects
method.22 All rates were calculated as
deaths per 100 total births, with total
births being the summation of live births
and fetal deaths. Subgroup analyses were
performed for the prevalence of IUFD
with the following stratifications: gestational age, early delivery plan, study site
(within US vs international), study
grading, and years in which the study
occurred.
Homogeneity across studies was
tested with the I2 index, which provides a
measure (or percentage) of the variation
in prevalence attributable to betweenstudy heterogeneity.23,24 An I2 value of
>75% is interpreted as high heterogeneity.24 Post-hoc sensitivity analyses
were conducted to investigate the potential sources of heterogeneity from
specific studies that may have biased the
analyses. Studies that potentially influenced heterogeneity were removed from
analyses, and the results were compared
with the original findings. A forest plot
was created to illustrate the prevalence of
each study, with 95% confidence intervals, that contributed to the analysis
along with the pooled prevalence estimate. Finally, all studies that reported
mean/median gestational ages of the live
births of gastroschisis were divided into
3 time periods: before 1990, 1990-1999,
and after 2000. The mean/median birth
rates of gastroschisis were described for
each time period to determine trends in
timing of delivery.
R ESULTS
Study and patient characteristics
Our search produced 1123 results. Review of these abstracts resulted in 100
AUGUST 2013 American Journal of Obstetrics & Gynecology
114.e2
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Obstetrics
articles for further review (Figure 1). Six
articles25-30 were excluded because of use
of overlapping datasets with articles that
were included in the analysis.13,31-34
Three articles were removed for having
<10 subjects.35-37 One article was
removed because it did not appear to
study consecutive cases of pregnancies
that were affected by gastroschisis and
thus did not reflect the total population
at risk,16 and 3 additional articles were
excluded for being case reports. We
included 54 eligible studies in the final
statistical analysis (Figure 2). Thirty-five
studies reported information regarding
gestational ages at the time of the IUFD
and/or a mean or median gestational age
at delivery. Nineteen articles included
the total number of IUFDs but did not
provide the gestational age of each IUFD.
Final eligible studies included 3276
total pregnancies that were affected by
gastroschisis (IUFD plus live births)
and 177 IUFDs. Of the 54 studies that
were included, 12 studies (22%) reported no IUFDs (Table 1). Sixteen
studies (30%) reported a planned elective delivery before onset of labor.
Seventeen studies (32%) took place in
the United States. The median gestational age of 48 IUFDs for which information was available was 33 weeks
(range, 18e41 weeks). For those studies
that reported a mean or median gestational age, the average reported mean
or median gestational age at delivery
for included studies was 35.7 weeks
(median, 36 weeks; range of medians,
34e37 weeks). Only 4 studies (7.4%)
had a quality grade of 5 (the highest
quality). Twenty-two studies (40.7%)
had a grade of 4; 14 studies (25.9%) had
a grade of 3; 11 studies (20.4%) had a
grade of 2, and only 3 studies had the
lowest grade of 1 (Table 2).
Metaanalysis
The pooled prevalence of IUFD for all
studies was 4.48 per 100 gastroschisis
pregnancies (live births þ IUFD; 95%
confidence interval [CI], 3.48e5.76).
There was no significant difference in
IUFD rate between centers with and
without an early delivery plan in place
(prevalence, 4.09; 95% CI, 2.39e6.91 vs
4.64; 95% CI, 3.47e6.17 per 100 births,
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FIGURE 1
Process of study selection
Flow diagram shows the number of citations that were identified, the exclusions with indications, and
the total articles for further analysis that are separated into those citations that included gestational
age (GA) for intrauterine fetal death (IUFD) and those without.
South. Risk of IUFD in gastroschisis. Am J Obstet Gynecol 2013.
respectively; P ¼ .7). The mean gestational age at delivery for those studies
that reported an early delivery plan was
not different from those studies in which
there was no delivery plan (prevalence,
35.5 0.83 (SD) vs 35.8 0.85; P ¼
.22). There was also no difference in
IUFD rate between studies conducted in
the United States vs outside the United
States (prevalence, 3.65; 95% CI,
2.26e5.84 vs 4.89; 95% CI, 3.63e6.56;
P ¼ .30). Twenty-two of the 54 publications (40.7%) reported on study
populations or study sites within the
United States while 3 were from Canada.
Three studies were from Asia (2 Japan, 1
China), and 1 study was from South
America (Brazil). The remaining studies
were from the United Kingdom, Europe,
or Australia. The 3 studies from Asia had
relatively high rates of IUFD that ranged
from 8.33e15.38 per 100 births. These
studies also had study years beginning in
the 1980s; therefore, rates may reflect
the practices of that region and time.
The prevalence of IUFD across the
publication years was quite variable,
with a range from 0 (2000 and 2004) to
13.8 per 100 births (2010). The highest
rates occurred in 1986 (13.3 per 100
births), 1990 (13.4 per 100 births), and
2010. No significant trends were seen
among other years (P ¼ .8, with the use
of a simple regression model).
Thirty-five articles described gestational age at the time of IUFD, which
totaled 37% (n ¼ 66) of all identified
IUFDs. Fourteen of 66 IUFDs (21%)
occurred at 36 weeks’ gestation.
Figure 3 shows the prevalence of IUFD at
each gestational age and cumulative
prevalence of IUFD across each gestational age. Nineteen percent of IUFDs
occurred at 30 weeks’ gestation. The
pooled prevalence of IUFD that occurred
at 36 weeks’ gestation was 1.28 per 100
births (95% CI, 0.72e2.26). The weekly
prevalence of IUFD did not appear to
increase at >35 weeks’ gestation. The
difference between this graph of crude
Obstetrics
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36 weeks’ gestation were 50% and
37%, respectively. The proportions that
occurred at 35 weeks were 21.4% and
42%, respectively. This temporal pattern
did not vary significantly when alternative grouping strategies were used.
Twenty-eight studies reported at least
1 termination of pregnancy. There was
no difference in the prevalence of IUFD
among studies that reported a termination of pregnancy and studies that had
none or were not reported (P ¼.63). The
pooled prevalence of IUFD among
studies with elective termination was
4.21 (95% CI, 2.93e6.03), compared
with 4.77 (95% CI, 3.32e6.81) among
studies without a case of elective
termination.
The 12 studies in which there were no
reported fetal death included a total of
369 cases. These studies, which represent
11% of the total number of cases that
were included in the metaanalysis,
appeared to have a slightly lower gestational age at delivery (35.1 0.99
weeks), compared with studies that reported at least 1 IUFD (35.9 0.70
weeks; P ¼ .01). We were unable to
identify a pattern of differences in
management or study methods between
those studies with and those without
reported IUFDs in terms of quality score,
geographic location, or reporting of an
obstetric delivery plan.
FIGURE 2
Forest plot shows odds ratios (random effect model)
prevalence estimates and the pooled
prevalence estimates for gestational age
of 36 weeks is that the metaanalysis
included all IUFDs that occurred at
36 weeks, although the graph only includes IUFDs up to 38 weeks’ gestation.
In addition, the metaanalysis weights
the prevalence calculations based on
sample size of the studies, which can also
Research
add to the differences in the 2 point
estimates.
Thirty-seven studies reported a mean/
median gestational age for live births.
The proportion of deliveries that
occurred at 37 weeks’ gestation was no
different between the 90s and 2000s (2
decades, 14% and 15.8%, respectively).
The proportions that occurred at
Sensitivity analysis
A pooled prevalence was calculated that
included only those studies (n ¼ 35)
that reported a gestational age at the
time of the IUFD. Among the 35 articles,
there were 1483 infants (births þ
IUFDs) and 60 IUFDs. The pooled
prevalence among these studies was 3.80
(95% CI, 2.68e5.35), which is consistent with findings of all included
studies. When we restricted the analysis
only to the 26 studies that had a quality
grade of 4 or 5 (n ¼ 1411 IUFD þ live
births), the pooled prevalence was 5.6
per 100 births (95% CI, 4.01e7.89).
Among the 14 studies with lowest
quality grades of 1 or 2, the pooled
prevalence rate was 4.49 (95% CI,
2.81e7.08; Table 2). None of the 5
quality assessment variables were related independently to risk for IUFD.
114.e4
Characteristics of the studies that were included in the systematic review
Intrauterine
Total, Spontaneous Termination of fetal death,
n
abortion, n pregnancy, n n/N (%)
Gestational age
at birth, wk D d
Gestational age Quality
of intrauterine assessment
fetal death, wk score
Abuhamad
et al, 199754
VA
PR
NR
17
NR
0
1/17 (6)
No standard
delivery plan
35.8a 2.74
28
4
Adair et al,
199655
NC
RR
1985-1994
29
NR
0
4/29 (13.8)
No standard
delivery plan
NR
28-41
2
Adra et al,
199656
FL
RR
1986-1994
47
NR
3
2/44 (4.5)
No standard
delivery plan
36.0a 2.4
28, 36
4
Ajayi et al,
201157
OH
RR
2000-2008
74
NR
0
0/74
Elective delivery
at 36-37 wks’
gestation
35.2b
(26.3e38.1)
N/A
3
Alfaraj et al,
201158
Canada
RR
2001-2010
98
NR
0
1/98 (1.0)
NR
NR
NR
2
Alsulyman
et al, 199659
LA
RR
1988-1995
23
NR
1
0/22
NR
34.3a 6.3
N/A
4
Axt et al,
199960
Germany
RR
1989-1997
18
NR
3
0/15
NR
36.1a 3.1
N/A
4
Badillo et al,
200861
PA
RR
2000-2007
64
NR
1
2/63 (3.2)
NR
NR
NR
2
Barisic et al,
200162
11 European RR
nations
1996-1998
106
NR
31
13/75 (17.3)
NR
36.3a 2.2
NR
3
Bond et al,
198833
CA
RR
1982-1986
15
NR
3
0/11
NR
NR
N/A
2
Boyd et al,
199845
UK
RR
1985-1995
41
NR
7
0/34
NR
37c
N/A
3
Brantberg
et al, 200463
Norway
PR
1988-2002
64
NR
3
1/61 (1.6)
C/S at 37-39 wks’
gestation
36 þ 1
(28e39)b
35 þ 5
5
Bugge and
Holm, 200234
Denmark
RR
1970-1989
166
NR
NR
9/166 (3.3)
NR
NR
NR
2
Burge and
Ade-Ajayi,
199712
UK
RR
1982-1995
57
NR
0
3/54 (5.6)
Spontaneous
labor
36a
32, 36, 39
4
Calzolari
et al, 199538
Italy
PR
1980-1990
274
NR
NR
NR
20-27 (n = 18)
NR (n = 22)
3
Delivery plan
40/274 (14.6) NR
(continued)
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Origin
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Study Study
design years
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TABLE 1
Characteristics of the studies that were included in the systematic review (continued)
Intrauterine
n
Delivery plan
Gestational age
at birth, wk D d
Chen et al,
199664
China
RR
1/1987-9/1994
15
NR
2
2/13 (15.4)
NR
NR
NR
2
Chescheir
et al, 199165
NC
RR
1986-1990
19
NR
0
1/19 (5.3)
NR
NR
28
3
Cohen-Overbeek The
RR
et al, 200866
Netherlands
1/1991-6/2003
33
NR
2
3/31 (9.7)
Induction at
37 wks’ gestation
NR
19, 33, 36
3
Crawford
et al, 199213
UK
RR
1986-1991
26
NR
2
3/24 (12.5)
No standard
delivery plan
NR
34, 35, 37
4
Dillon and
Renwick,
199567
UK
PR
1988-1992
56
3
2
3/51 (5.9)
No standard
delivery plan
NR
32, 32, 37
4
Durfee
et al, 200268
MA
RR
4/1990-12/2000
26
NR
2
0/24
NR
NR
N/A
2
Eurenius and
Axelsson,
199469
Sweden
RR
1983-1990
24
NR
4
1/20 (5.0)
NR
NR
NR
2
Feldkamp
et al, 200870
UT
PR
1/1997-12/2005 189
NR
3
11/186 (5.9)
NR
NR
NR
2
Fillingham and
Rankin, 200871
UK
RR
1/97-12/06
143
NR
3
2/140 (1.4)
NR
NR
NR
2
Fitzsimmons
et al, 198872
WA
RR
1/1980-12/1986
15
NR
0
1/15 (6.7)
C/S at 36 wks’
gestation
35.9b (31e37)
41
3
Forrester and
Merz, 199973
HI
RR
1986-1997
74
NR
6
7/68 (10.3)
NR
NR
NR
1
Fratelli et al,
200732
UK
RR
1/1997-4/2006
40
NR
2
2/38 (5.3)
Induction at
38-39 wks’
gestation
37 þ 1
(36 þ 0 to
38 þ 1)c
18, 22
4
Garcia et al,
201074
Brazil
RR
1/1997-8/2009
94
NR
NR
5/94 (5.3)
Elective C/S at
37 wks’ gestation
36.5 1.4a
32, 34, 35,
36, 37
4
Garne et al,
200711
Denmark
and UK
RR
1997-2002
216
NR
39
9/177 (5.1)
NR
36c
NR
3
Goldkrand
et al, 200475
GA
RR
1/1994-9/2002
34
NR
NR
2/34 (5.8)
Planned delivery
at >37 wks’
gestation
NR
32.7, 36
3
114.e6
(continued)
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Origin
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design years
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TABLE 1
Intrauterine
n
Gestational age
at birth, wk D d
Heinig et al,
200876
Germany
RR
10/2001-9/2005
14
NR
NR
2/14 (14.3)
C/S at 37-39 wks’
gestation
33 þ 6 to 36 þ 6
33 þ 6, 35 þ 3 4
Hidaka et al,
200977
Japan
RR
1990-2006
11
NR
NR
1/11 (9.1)
C/S at 37-38 wks’
gestation
NR
35
4
Horton et al,
201078
NC
RR
1/2000- 1/2907
71
NR
NR
2/71 (2.8)
Spontaneous labor
35 þ 4 2.4a
27, 33
4
Huang et al,
200279
RI
RR
1991-2001
60
NR
NR
3/60 (5.0)
NR
NR
NR
1
Japaraj et al,
200380
Australia
RR
1/1993-5/2001
45
NR
NR
0/45
NR
35.6b (24e39)
N/A
3
Kamata et al,
199681
Japan
RR
1982-1994
12
NR
NR
1/12 (8.3)
Spontaneous labor
35.4a 3.7
31
4
Lafferty et al,
198982
UK
RR
1981-1986
27
NR
4
1/23 (4.3)
Spontaneous labor
37.2b
(33.5e40.0)
37
3
Lausman et al,
20077
Canada
RR
1/1980- 12/2001 158
1
3
2/154 (1.3)
Eighty-six women
36.6 2a
had spontaneous
labor; 66 women
had planned delivery
24, 35
4
Logghe et al,
200550
UK
RCT
5/1995- 9/1999
42
NR
NR
1/42 (2.4)
Two groups of 21
women randomly
assigned to induction
at 36 wks’ gestation
or spontaneous
delivery
31
5
Mears et al,
201083
UK
RR
2004-2008
60
NR
0
3/60 (5.0)
Induction at 37 wks’ 36a
gestation
NR
3
Moir et al,
200484
MN
PR
NR
27
NR
0
0/27
Deliver at >29 wks’
gestation and 3/4
criteria: (1) maximum
bowel diameter
>10 mm, (2) wall
thickness >2 mm,
(3) lack of peristalsis,
(4) intestinal matting
Delivery plan:
34.2 2.4a;
controlled trial:
37.7 1.8a
N/A
5
Morrow et al,
199385
Scotland
RR
1983-1989
47
6
11
2/30 (6.7)
NR
36b (31e38)
>28 (n = 2)
2
Delivery plan
Induction:
35.8 0.7a;
spontaneous:
36.7 1.5a
(continued)
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Origin
Obstetrics
Study
Study Study
design years
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TABLE 1
Intrauterine
n
Delivery plan
Gestational age
at birth, wk D d
Nicholas et al,
200986
WA
RR
1991-2006
80
NR
4
2/76 (2.6)
Spontaneous labor
NR
NR
2
Rankin et al,
199987
UK
RR
1986-1996
126
NR
12
4/108 (3.7)
NR
NR
NR
3
Reid et al,
200331
Australia
PR
1980-2001
122
NR
NR
12/122 (9.8)
Elective delivery
37c (24e41)
at 38 wks’ gestation
34c (24e39)
5
Reigstad
et al, 201188
Norway
RR
1993-2008
36
NR
0
6/36 (17)
Two groups: (1)
Group 1: 36.5
spontaneous labor
(34e40)c; group 2:
(n = 10); (2)
35.0 (34e37)c
elective C/S at
36-37 wks’ gestation
(n = 20)
<20 (n = 3)
28, 29, 39
4
Rinehart et al,
199989
MS
RR
9/1992-6/1998
33
NR
1
0/32
NR
Outside center:
N/A
35.3 2.2a; tertiary
center: 35.6 1.4a
3
Salomon et al,
200451
France
PR
3/1998-7/2001
31
NR
1/31 (3.2)
NR
Low risk (n ¼ 20
NR
women): 35.5
(32e38)c; high
risk (n ¼ 11 women:
34.5 (32e36)c
3
Santiago-Munoz US
et al, 200790
RR
1/1998-6/2006
66
NR
3/66 (4.5)
Spontaneous labor
37.1 1.9a
33, 38, 40
4
Serra et al,
200848
Germany
RR
1999-2004
23
NR
0/23
Two groups: (1)
C/S at 34 wks’
gestation; (2)
spontaneous labor
Group 1: 243
(226e264) daysc;
group 2: 257
(235e282) daysc
N/A
4
Sipes et al,
199091
IA, WI
RR
12/1979-1/1989
33
NR
0/32
Spontaneous labor
36.3 2.4a
N/A
3
Skarsgard
et al, 200839
Canada
RR
2005-2006
114
NR
1/107 (0.9)
NR
35.9 2.3a
NR
2
Towers and
Carr, 200892
US
RR
1/1986-12/2003
85
NR
0
2/84 (2.4)
Spontaneous labor
NR
29 þ 4,
31 þ 3
4
Vegunta et al,
200593
IL
RR
6/1998-8/2002
30
NR
0
0/30
C/S 36-38 wks’
gestation
35.7 (28.4e38.6)c
N/A
3
0
1
3 (4 lost to
follow up)
C/S, cesarean section delivery; N/A, not applicable; NR, not reported; PR, prospective observational review; RCT, randomized controlled trial; RR, retrospective review.
114.e8
a
Data were reported as mean SD; b Data were reported as mean (range); c Data were reported as median (range).
Research
Origin
Obstetrics
Study
Study Study
design years
www.AJOG.org
TABLE 1
Research
Obstetrics
Heterogeneity
We detected moderate heterogeneity
across studies (I2 ¼ 63%), which indicated moderate between-studies variability. This likely is due to differences in
the definition of IUFD (gestational age
cutoff for spontaneous abortion vs
IUFD) and practice variability in the
management of gastroschisis pregnancies. Because 12 studies reported no
cases of IUFD, these 12 studies were not
included in the initial assessment of
heterogeneity (they provided no estimates of variances for prevalence rates).
To estimate their contribution if they had
reported IUFDs, we assumed 1 case
occurred in each study and then recalculated the I2, which decreased slightly
from 63% to 56%. We investigated each
study’s individual contribution to the
heterogeneity by removing each study
individually from the analysis and
recalculating the pooled results, which
included the assessment of the 12 studies
that had the largest sample sizes (n >
100). Results indicated that the article by
Calzolari et al38 (prevalence, 14.6 per 100
births; 95% CI, 10.78e19.16) contributed the most to the I2 (pooled prevalence without the study of Calzolari et al,
4.47; 95% CI, 3.46e5.76; I2 ¼ 55%].
Skarsgard et al39 also contributed
significantly to the heterogeneity (prevalence, 0.94 per 100 births; 95% CI,
0.05e4.56; pooled prevalence without
Skarsgard, 4.40; 95% CI, 3.40e5.67; I2 ¼
43%]. The removal of both of these
studies decreased the I2 to 46%.
www.AJOG.org
TABLE 2
Pooled prevalence of intrauterine fetal death by graded quality of study
Grade
Studies, n
Pregnancies, n
Pooled prevalence per 100 births
95% CI
1, 2
14
1262
4.49
2.81e7.08
3
14
603
2.50
1.29e4.78
4, 5
26
1411
5.65
4.01e7.89
CI, confidence interval.
infants without congenital anomalies,
Young et al40 showed decreasing mortality rates at 34, 35, and 36 weeks’
gestation, compared with term infants
(risk ratio, 10.5, 7.2, and 5.3, respectively). Neonatal intensive care unit admissions for respiratory issues were also
more common among infants who were
born late preterm.41 Longer-term complications have also been described. Late
preterm infants were found to have
increased intensive care admissions
because of respiratory syncytial virus,
with increased length of hospitalization,
compared with term infants.42 In
addition, late preterm birth has been
associated with cerebral palsy, cognitive
and developmental delay, and behavioral
problems.43 Because of these apparent
risks that are associated with early delivery, the March of Dimes is leading an
effort to reset the obstetric paradigm by
advocating a decrease in the number of
normal pregnancies electively delivered
at <39 weeks’ gestation.44
The published literature on longterm developmental outcomes that are
associated with gastroschisis is sparse,
which leaves us with little data regarding the effect of gestational age on
FIGURE 3
Prevalence of intrauterine fetal death by gestational age
C OMMENT
The optimal timing for delivery of infants with gastroschisis is unknown,
because there are both risks and benefits
associated with elective delivery before
term. The possibility of fetal death is a
major factor in the determination of
appropriate obstetric management. The
identification of an accurate risk profile
for IUFD is essential for clinicians to
assess risks and benefits appropriately
and therefore develop an obstetrics
management plan.
In the general population, late preterm delivery (34-36 weeks’ gestation) is
associated with increased morbidity and
mortality rates. Among a cohort of
Cumulative and weekly prevalence of intrauterine fetal death per 100 pregnancies. Blue lines
indicate weekly prevalence of intrauterine fetal death; red lines indicate cumulative prevalence of
intrauterine fetal death.
Obstetrics
www.AJOG.org
these outcomes. Although children with
gastroschisis have been reported to have
both normal45 and delayed development,46 studies have been limited by
small sample sizes, noncontemporary
cohorts, and a lack of formal developmental testing. The most detailed
contemporary formal developmental
data suggests that preterm birth in infants with gastroschisis may influence
both cognitive and motor development.47 Given the lack of definitive data,
in addition to the lack of a compelling hypothesis that would suggest
otherwise, we speculate that infants with
gastroschisis who are born prematurely
experience equal or worse outcomes,
compared with preterm infants without
this congenital anomaly. Thus, there is
potential for benefit in delaying delivery
in pregnancies that are affected by
gastroschisis.
The developmental benefits of delaying delivery must be balanced with all
other known risks and benefits. Some
clinicians theorize that prolonged exposure to amniotic fluid increases bowel
damage and dysmotility and therefore
advocate for routine early delivery in
pregnancies that are complicated by
gastroschisis. One small cohort study
showed decreased time to the initiation
of feeding and decreased length of stay
with planned cesarean section delivery at
34 weeks’ gestation.48 However, other
retrospective studies report worse outcomes that are related to preterm delivery of neonates with gastroschisis,
compared with term delivery. Boutros
et al49 described an inverse relationship
between gestational age and ventilator
days, time on parenteral nutrition, and
length of stay. An additional small randomized controlled trial showed no
difference in outcomes between elective
delivery at 36 weeks’ gestation compared
with spontaneous labor50; however, the
sample size may not have been sufficient
to detect a difference because many
pregnancies with gastroschisis will
deliver spontaneously before term.
Results of this metaanalysis suggest a
pooled prevalence of IUFD with gastroschisis of 4.48 per 100 births, which is
much lower than previously cited but
higher than the general population. The
prevalence of IUFD did not increase
during late gestation. The overall risk of
IUFD is greatest at <36 weeks’ gestation,
which is earlier than many obstetricians
would consider routine elective delivery.
It appears that, once a fetus has
completed 35 weeks’ gestation, it already
has assumed most of the risk of IUFD;
therefore, fetal death should not weigh as
heavily in the decision electively deliver
early. However, we must point out that
the methods used to generate our estimates of IUFD assume the denominator
to be constant. Because of the high rate
of early deliveries, this assumption limits
our ability to calculate prospectively the
risk for fetal death at advanced gestational ages. Furthermore, data regarding
additional anomalies and comorbidities
were provided only rarely in the
reviewed articles. Therefore, we were
unable to control for other extraneous
factors that may have led to fetal death,
such as abnormal karyotype, additional
congenital anomalies, or other related
factors such as intestinal dilation.
Our objective in evaluating the presence of a delivery plan was to determine
whether having a clearly stated delivery
process decreased the likelihood of
death. We did not intend to evaluate the
merits of any individual plan. The reported delivery plans differed greatly in
both the antenatal monitoring and proposed goal for gestational age at delivery.
Our results suggest that having a delivery
plan (1) does not alter the rate of IUFD
and (2) does not change the gestational
age at delivery. The reason the delivery
plan may not influence outcomes is that
either the delivery plan is not adhered to
or the studies in which no delivery plan
is reported have a practice of early,
elective delivery. We suspect that both of
these possibilities contributed to our
observations. Additional study of antenatal risk factors and comprehensive
delivery plans may allow for individualized approaches to planning the timing
of delivery. Identification of those pregnancies that would benefit from early
delivery would optimize outcomes
without compromising those who would
not benefit.
We believe that multiple factors influence caregiver decisions regarding the
Research
timing of nonspontaneous deliveries
that are affected by gastroschisis. The
risk of ongoing visceral injury is a
prominent concern. However, in the
absence of specific compromise of bowel
integrity (ie, dilation), there is not
consistent evidence in the literature that
supports the practice of routine early
delivery to improve gut-related outcomes. In our experience, the risk for
fetal death is the primary driver of early
elective delivery. Misrepresentation of
risk in the literature and anecdotal evidence play key roles in perpetuating this
practice.
Our study also suggests that the
gestational age at delivery for pregnancies that are affected by gastroschisis is
decreasing over time. We speculate that,
as prenatal diagnosis has become more
common, the opportunity for obstetric
intervention in the timing of delivery has
increased. This likely has led to either an
increase in elective early deliveries or an
increase in indicated early deliveries. The
role of each is impossible to determine
based on the current literature. The
causal relationship between earlier delivery and fetal or postnatal death is not
clear. The role of fetal monitoring in the
prevention of IUFD in gastroschisis is
not well established. Most accounts of
antenatal management in the published
literature describe the inclusion of
increased antenatal monitoring, which
includes increased frequency of ultrasound scanning, tococardiography, and
other measures of fetal well-being.
Despite this medical practice, there is
little evidence to suggest that antenatal
monitoring improves survival or other
neonatal outcomes in this population.51,52 This may be because fetal death
in gastroschisis is an acute event without
preceding indicators.
Our study has certain limitations.
First, our results may be influenced by
early elective delivery that eliminated
potential IUFDs. When we compared
studies with and without an early elective
delivery plan, we found no significant
difference in outcomes of IUFD. However, this finding may be the result of
improved prenatal monitoring practices.
The use of ultrasound scanning and
biophysical profiles to assess for the
114.e10
Research
Obstetrics
compromised fetus and the increased
awareness of IUFD may contribute to
overall fetal survival. Second, although
the risk for IUFD has decreased, the
postnatal mortality rate may have
increased. We found a pooled prevalence
of postnatal survival of 95%. These results are similar to those published by
Vachharajani et al,53 who reported a
postnatal survival of approximately
90%. These improvements in postnatal
survival most likely are related to the
advances in total parental nutrition,
surgical care, antibiotics, and tertiary
neonatal intensive care units. Finally, our
results may be influenced by ascertainment or referral bias. If referral bias were
to be present, by concentrating the most
severely affected pregnancies in tertiary
care centers, our outcomes should be
biased to overestimate the rate of IUFD.
We attempted to limit this bias by
including larger, population-based published cohorts. We cannot, however, account for gastroschisis cases that were
not diagnosed before delivery.
This metaanalysis seeks to provide
more evidence to consider in decisionmaking for the timing of the delivery in
gastroschisis. Normal neonates without
congenital defects are at a higher risk of
morbidity and death when they are
delivered prematurely, which has resulted in a trend in the United States to
delay the timing of elective deliveries to
>39 weeks’ gestation. The risk of IUFD
in gastroschisis is lower than is cited
commonly; however, the implications of
even a single potentially preventable
death are significant. Given the small
incremental increase in risk for IUFD
with advancing gestational age, we
advocate for strategies to delay elective
delivery before term in the stable patient
with gastroschisis. Elective delivery at
>36 completed weeks’ gestation may be
an appropriate balance of risks and
benefits. Given the lack of data regarding
fetal death in the setting of in utero
growth restriction or bowel dilation, we
cannot advocate for changes in current
management strategies. Although there
is no strong evidence that antenatal fetal
monitoring prevents IUFD in gastroschisis,51,52 there may be a benefit to
increased monitoring at 36 weeks’
www.AJOG.org
gestation, with a plan to deliver at
37 weeks’ gestation. Antenatal markers
that include cytokine profiles, oligohydramnios, and bowel dilation have been
evaluated yet have not been shown to be
predictive of outcomes in gastroschisis.17
Throughout pregnancy, the pooled
prevalence of IUFD in gastroschisis is
7-fold higher (4.48%) than that of the
general population (0.62%). Furthermore, at >36 weeks’ gestation, our data
suggest that the risk for IUFD is still
significantly higher than the general
obstetric population, thus making the
question of antenatal monitoring pertinent. The current paucity of data does
not allow for early identification of individual infants who are likely to experience bad outcomes. Despite this,
ultrasound findings that are consistent
with increasing intraabdominal size or
dilation may warrant earlier delivery
because of risks of postnatal morbidity.
Large, prospective, multicenter evaluations of prenatal risk factors for IUFD
are needed, along with randomized trials
that are designed to determine optimal
timing of delivery in pregnancies that are
affected by IUFD.
REFERENCES
1. Castilla EE, Mastroiacovo P, Orioli IM.
Gastroschisis: international epidemiology and
public health perspectives. Am J Med Genet
2008;148C:162-79.
2. Bradnock TJ, Marven S, Owen A, et al.
Gastroschisis: one year outcomes from national
cohort study. BMJ 2011;343:d6749.
3. Dolk H, Loane M, Garne E. The prevalence of
congenital anomalies in Europe. Adv Exp Med
Biol 2010;686:349-64.
4. MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. Natl Vital
Stat Rep 2009;57:1-19.
5. Centers for Disease Control and Prevention.
National Center for Health Statistics. VitalStats.
Available at: http://www.cdc.gov/nchs/vitalstats.
htm. Accessed Aug. 21, 2012.
6. Craigo SD. Indicated preterm birth for fetal
anomalies. Semin Perinatol 2011;35:270-6.
7. Lausman AY, Langer JC, Tai M, et al. Gastroschisis: what is the average gestational age of
spontaneous delivery? J Pediatr Surg 2007;42:
1816-21.
8. Barseghyan K, Aghajanian P, Miller DA. The
prevalence of preterm births in pregnancies
complicated with fetal gastroschisis. Archives of
gynecology and obstetrics 2012;286(4):889-92.
9. Simmons M, Georgeson KE. The effect of
gestational age at birth on morbidity in patients
with gastroschisis. J Pediatr Surg 1996;31:
1060-2.
10. Ergün O, Barksdale E, Ergün FS, et al. The
timing of delivery of infants with gastroschisis
influences outcome. J Pediatr Surg 2005;40:
424-8.
11. Garne E, Loane M, Dolk H. Gastrointestinal
malformations: impact of prenatal diagnosis on
gestational age at birth. Paediatr Perinat Epidemiol 2007;21:370-5.
12. Burge DM, Ade-Ajayi N. Adverse outcome
after prenatal diagnosis of gastroschisis: the role
of fetal monitoring. J Pediatr Surg 1997;32:
441-4.
13. Crawford RA, Ryan G, Wright VM,
Rodeck CH. The importance of serial biophysical assessment of fetal wellbeing in gastroschisis. BJOG 1992;99:899-902.
14. Kalache KD, Bierlich A, Hammer H,
Bollmann R. Is unexplained third trimester intrauterine death of fetuses with gastroschisis
caused by umbilical cord compression due to
acute extra-abdominal bowel dilatation? Prenatal Diagn 2002;22:715-7.
15. Sapin E, Mahieu D, Borgnon J, Douvier S,
Carricaburu E, Sagot P. Transabdominal
amnioinfusion to avoid fetal demise and intestinal damage in fetuses with gastroschisis and
severe oligohydramnios. J Pediatr Surg 2000;
35:598-600.
16. Carroll SG, Kuo PY, Kyle PM, Soothill PW.
Fetal protein loss in gastroschisis as an explanation of associated morbidity. Am J Obstet
Gynecol 2001;184:1297-301.
17. Luton D, De Lagausie P, Guibourdenche J,
et al. Prognostic factors of prenatally diagnosed
gastroschisis. Fetal Diagn Ther 1997;12:7-14.
18. Guibourdenche J, Berrebi D, Vuillard E, et al.
Biochemical investigations of bowel inflammation in gastroschisis. Pediatr Res 2006;60:
565-8.
19. Bhatia AM, Musemeche CA, Crino JP.
Gastroschisis complicated by midgut atresia
and closure of the defect in utero. J Pediatr Surg
1996;31:1288-9.
20. Luppa M, Sikorski C, Luck T, et al. Age- and
gender-specific prevalence of depression in
latest-life: systematic review and meta-analysis.
J Affect Disord 2012;136:212-21.
21. Hedges L, Vevea J. Fixed- and randomeffects models in meta-analysis. Psychol Meth
1998;3:486-504.
22. DerSimonian R, Laird N. Meta-analysis in
clinical trials. Control Clin Trials 1986;7:177-88.
23. Higgins JP, Thompson SG. Quantifying
heterogeneity in a meta-analysis. Stat Med
2002;21:1539-58.
24. Higgins JP, Thompson SG, Deeks JJ,
Altman DG. Measuring inconsistency in metaanalyses. BMJ 2003;327:557-60.
25. Byron-Scott R, Haan E, Chan A, Bower C,
Scott H, Clark K. A population-based study of
abdominal wall defects in South Australia and
Western Australia. Paediatr Perinat Epidemiol
1998;12:136-51.
26. Sharp M, Bulsara M, Gollow I, Pemberton P.
Gastroschisis: early enteral feeds may improve
Obstetrics
www.AJOG.org
outcome. J Paediatr Child Health 2000;36:
472-6.
27. Contro E, Fratelli N, Okoye B,
Papageorghiou A, Thilaganathan B, Bhide A.
Prenatal ultrasound in the prediction of bowel
obstruction in infants with gastroschisis. Ultrasound Obstet Gynecol 2010;35:702-7.
28. Fisher R, Attah A, Partington A, Dykes E.
Impact of antenatal diagnosis on incidence and
prognosis in abdominal wall defects. J Pediatr
Surg 1996;31:538-41.
29. Grundy H, Anderson RL, Filly RA, et al.
Gastroschisis: prenatal diagnosis and management. Fetal Ther 1987;2:144-7.
30. Garne E, Rasmussen L, Husby S. Gastrointestinal malformations in Funen county,
Denmark: epidemiology, associated malformations, surgery and mortality. Eur J Pediatr Surg
2002;12:101-6.
31. Reid KP, Dickinson JE, Doherty DA. The
epidemiologic incidence of congenital gastroschisis in Western Australia. Am J Obstet
Gynecol 2003;189:764-8.
32. Fratelli N, Papageorghiou AT, Bhide A,
Sharma A, Okoye B, Thilaganathan B. Outcome
of antenatally diagnosed abdominal wall defects.
Ultrasound Obstet Gynecol 2007;30:266-70.
33. Bond SJ, Harrison MR, Filly RA, Callen PW,
Anderson RA, Golbus MS. Severity of intestinal
damage in gastroschisis: correlation with prenatal sonographic findings. J Pediatr Surg 1988;
23:520-5.
34. Bugge M, Holm NV. Abdominal wall defects
in Denmark, 1970-89. Paediatr Perinatal Epidemiol 2002;16:73-81.
35. Arnaoutoglou
C,
Keivanidou
A,
Arnaoutoglou M, et al. Outcome of antenatally
diagnosed fetal anterior abdominal wall defects
from a single tertiary centre. Fetal Diagn Ther
2008;24:416-9.
36. Cedergren M, Selbing A. Detection of fetal
structural abnormalities by an 11-14-week
ultrasound dating scan in an unselected
Swedish population. Acta Obstet Gynecol
Scand 2006;85:912-5.
37. Redford DH, McNay MB, Whittle MJ. Gastroschisis and exomphalos: precise diagnosis by
midpregnancy ultrasound. BJOG 1985;92:54-9.
38. Calzolari E, Bianchi F, Dolk H, Milan M.
Omphalocele and gastroschisis in Europe: a
survey of 3 million births 1980-1990. EUROCAT
Working Group. Am J Med Genet 1995;58:
187-94.
39. Skarsgard ED, Claydon J, Bouchard S,
et al. Canadian Pediatric Surgical Network: a
population-based pediatric surgery network
and database for analyzing surgical birth defects: the first 100 cases of gastroschisis.
J Pediatr Surg 2008;43:30-4.
40. Young PC, Glasgow TS, Li X, GuestWarnick G, Stoddard G. Mortality of late-preterm
(near-term) newborns in Utah. Pediatrics 2007;
119:e659-65.
41. Ramachandrappa A, Jain L. Health issues of
the late preterm infant. Pediatr Clin North Am
2009;56:565-77, Table of Contents.
42. Kotecha SJ, Dunstan FD, Kotecha S. Long
term respiratory outcomes of late preterm-born
infants. Semin Fetal Neonatal Med 2012;17:
77-81.
43. Boyle JD, Boyle EM. Born just a few weeks
early: does it matter? Arch Dis Child Fetal
Neonatal Ed 2013;98:F85-8.
44. Howse JL, Katz M. Conquering prematurity.
Pediatrics 2013;131:1-2.
45. Boyd PA, Bhattacharjee A, Gould S,
Manning N, Chamberlain P. Outcome of prenatally diagnosed anterior abdominal wall defects. Arch Dis Child Fetal Neonatal Ed 1998;78:
F209-13.
46. Berseth CL, Malachowski N, Cohn RB,
Sunshine P. Longitudinal growth and late
morbidity of survivors of gastroschisis and
omphalocele. J Pediatr Gastroenterol Nutr
1982;1:375-9.
47. South AP, Marshall DD, Bose CL,
Laughon MM. Growth and neurodevelopment
at 16 to 24 months of age for infants born with
gastroschisis. J Perinatol 2008;28:702-6.
48. Serra A, Fitze G, Kamin G, Dinger J,
König IR, Roesner D. Preliminary report on
elective preterm delivery at 34 weeks and primary abdominal closure for the management
of gastroschisis. Eur J Pediatr Surg 2008;18:
32-7.
49. Boutros J, Regier M, Skarsgard ED. Is
timing everything? The influence of gestational
age, birth weight, route, and intent of delivery on
outcome in gastroschisis. J Pediatr Surg
2009;44:912-7.
50. Logghe HL, Mason GC, Thornton JG,
Stringer MD. A randomized controlled trial of
elective preterm delivery of fetuses with gastroschisis. J Pediatr Surg 2005;40:1726-31.
51. Salomon LJ, Mahieu-Caputo D, Jouvet P,
et al. Fetal home monitoring for the prenatal
management of gastroschisis. Acta Obstet
Gynecol Scand 2004;83:1061-4.
52. Overton TG, Pierce MR, Gao H, et al. Antenatal management and outcomes of gastroschisis
in the U.K. Prenatal Diagn 2012;32:1256-62.
53. Vachharajani AJ, Dillon PA, Mathur AM.
Outcomes in neonatal gastroschisis: an institutional experience. Am J Perinatol 2007;24:461-5.
54. Abuhamad AZ, Mari G, Cortina RM,
Croitoru DP, Evans AT. Superior mesenteric
artery Doppler velocimetry and ultrasonographic
assessment of fetal bowel in gastroschisis: a
prospective longitudinal study. Am J Obstet
Gynecol 1997;176:985-90.
55. Adair CD, Rosnes J, Frye AH, Burrus DR,
Nelson LH, Veille JC. The role of antepartum
surveillance in the management of gastroschisis.
Int J Gynaecol Obstet 1996;52:141-4.
56. Adra AM, Landy HJ, Nahmias J, GómezMarín O. The fetus with gastroschisis: impact of
route of delivery and prenatal ultrasonography.
Am J Obstet Gynecol 1996;174:540-6.
57. Ajayi FA, Carroll PD, Shellhaas C, et al.
Ultrasound prediction of growth abnormalities
in fetuses with gastroschisis. J Matern Fetal
Neonatal Med 2011;24:489-92.
Research
58. Alfaraj MA, Ryan G, Langer JC, Windrim R,
Seaward PG, Kingdom J. Does gastric dilation
predict adverse perinatal or surgical outcome in
fetuses with gastroschisis? Ultrasound Obstet
Gynecol 2011;37:202-6.
59. Alsulyman OM, Monteiro H, Ouzounian JG,
Barton L, Songster GS, Kovacs BW. Clinical
significance of prenatal ultrasonographic intestinal dilatation in fetuses with gastroschisis. Am J
Obstet Gynecol 1996;175:982-4.
60. Axt R, Quijano F, Boos R, et al. Omphalocele and gastroschisis: prenatal diagnosis and
peripartal management: a case analysis of the
years 1989-1997 at the Department of Obstetrics and Gynecology, University of Homburg/Saar. Eur J Obstet Gynecol Reprod Biol
1999;87:47-54.
61. Badillo AT, Hedrick HL, Wilson RD, et al.
Prenatal ultrasonographic gastrointestinal abnormalities in fetuses with gastroschisis do not
correlate with postnatal outcomes. J Pediatr
Surg 2008;43:647-53.
62. Barisic I, Clementi M, Häusler M, et al.
Evaluation of prenatal ultrasound diagnosis of
fetal abdominal wall defects by 19 European
registries. Ultrasound Obstet Gynecol 2001;18:
309-16.
63. Brantberg A, Blaas HG, Salvesen KA,
Haugen SE, Eik-Nes SH. Surveillance and
outcome of fetuses with gastroschisis. Ultrasound Obstet Gynecol 2004;23:4-13.
64. Chen CP, Liu FF, Jan SW, Sheu JC,
Huang SH, Lan CC. Prenatal diagnosis and
perinatal aspects of abdominal wall defects.
Am J Perinatol 1996;13:355-61.
65. Chescheir NC, Azizkhan RG, Seeds JW,
Lacey SR, Watson WJ. Counseling and care for
the pregnancy complicated by gastroschisis.
66. Cohen-Overbeek TE, Hatzmann TR,
Steegers EA, Hop WC, Wladimiroff JW,
Tibboel D. The outcome of gastroschisis after
a prenatal diagnosis or a diagnosis only at
birth: recommendations for prenatal surveillance. Eur J Obstet Gynecol Reprod Biol
2008;139:21-7.
67. Dillon E, Renwick M. The antenatal diagnosis and management of abdominal wall defects: the northern region experience. Clin Radiol
1995;50:855-9.
68. Durfee SM, Downard CD, Benson CB,
Wilson JM. Postnatal outcome of fetuses
with the prenatal diagnosis of gastroschisis.
J Ultrasound Med 2002;21:269-74.
69. Eurenius K, Axelsson O. Outcome for fetuses with abdominal wall defects detected by
routine second trimester ultrasound. Acta
Obstet Gynecol Scand 1994;73:25-9.
70. Feldkamp ML, Alder SC, Carey JC. A case
control population-based study investigating
smoking as a risk factor for gastroschisis in
Utah, 1997-2005. Birth Defects Res Clin Mol
Teratol 2008;82:768-75.
71. Fillingham A, Rankin J. Prevalence, prenatal
diagnosis and survival of gastroschisis. Prenatal
Diagn 2008;28:1232-7.
114.e12
Research
Obstetrics
72. Fitzsimmons J, Nyberg DA, Cyr DR,
Hatch E. Perinatal management of gastroschisis. Obstet Gynecol 1988;71:910-3.
73. Forrester MB, Merz RD. Epidemiology of
abdominal wall defects, Hawaii, 1986-1997.
Teratology 1999;60:117-23.
74. Garcia L, Brizot M, Liao A, Silva MM,
Tannuri AC, Zugaib M. Bowel dilation as a predictor of adverse outcome in isolated fetal gastroschisis. Prenatal Diagn 2010;30:964-9.
75. Goldkrand JW, Causey TN, Hull EE. The
changing face of gastroschisis and omphalocele
in southeast Georgia. J Matern Fetal Neonatal
Med 2004;15:331-5.
76. Heinig J, Müller V, Schmitz R, Lohse K,
Klockenbusch W, Steinhard J. Sonographic
assessment of the extra-abdominal fetal small
bowel in gastroschisis: a retrospective longitudinal study in relation to prenatal complications.
Prenatal Diagn 2008;28:109-14.
77. Hidaka N, Murata M, Yumoto Y, et al.
Characteristics and perinatal course of prenatally diagnosed fetal abdominal wall defects
managed in a tertiary center in Japan. J Obstet
Gynaecol Res 2009;35:40-7.
78. Horton AL, Powell MS, Wolfe HM. Intrauterine growth patterns in fetal gastroschisis.
79. Huang J, Kurkchubasche AG, Carr SR,
Wesselhoeft CW Jr, Tracy TF Jr, Luks FL.
www.AJOG.org
Benefits of term delivery in infants with antenatally diagnosed gastroschisis. Obstet Gynecol
2002;100:695-9.
80. Japaraj RP, Hockey R, Chan FY. Gastroschisis: can prenatal sonography predict neonatal outcome? Ultrasound Obstet Gynecol
2003;21:329-33.
81. Kamata S, Ishikawa S, Usui N, et al. Prenatal
diagnosis of abdominal wall defects and their
prognosis. J Pediatr Surg 1996;31:267-71.
82. Lafferty PM, Emmerson AJ, Fleming PJ,
Frank JD, Noblett HR. Anterior abdominal wall
defects. Arch Dis Child 1989;64:1029-31.
83. Mears AL, Sadiq JM, Impey L, Lakhoo K.
Antenatal bowel dilatation in gastroschisis: a bad
sign? Pediatr Surg Int 2010;26:581-8.
84. Moir CR, Ramsey PS, Ogburn PL,
Johnson RV, Ramin KD. A prospective trial of
elective preterm delivery for fetal gastroschisis.
85. Morrow RJ, Whittle MJ, McNay MB,
Raine PA, Gibson AA, Crossley J. Prenatal
diagnosis and management of anterior abdominal wall defects in the west of Scotland. Prenatal
Diagn 1993;13:111-5.
86. Nicholas SS, Stamilio DM, Dicke JM,
Gray DL, Macones GA, Odibo AO. Predicting
adverse neonatal outcomes in fetuses with
abdominal wall defects using prenatal risk factors. Am J Obstet Gynecol 2009;201:383.e1-6.
87. Rankin J, Dillon E, Wright C. Congenital
anterior abdominal wall defects in the north of
England, 1986-1996: occurrence and outcome.
Prenatal Diagn 1999;19:662-8.
88. Reigstad I, Reigstad H, Kiserud T,
Berstad T. Preterm elective caesarean section
and early enteral feeding in gastroschisis. Acta
Paediatr 2011;100:71-4.
89. Rinehart BK, Terrone DA, Isler CM,
Larmon JE, Perry KG Jr, Roberts WE. Modern
obstetric management and outcome of infants
with gastroschisis. Obstet Gynecol 1999;94:
112-6.
PC,
McIntire
DD,
90. Santiago-Munoz
Barber RG, Megison SM, Twickler DM, Dashe JS.
Outcomes of pregnancies with fetal gastroschisis. Obstet Gynecol 2007;110:663-8.
91. Sipes SL, Weiner CP, Sipes DR 2nd,
Grant SS, Williamson RA. Gastroschisis and
omphalocele: does either antenatal diagnosis
or route of delivery make a difference in perinatal
outcome? Obstet Gynecol 1990;76:195-9.
92. Towers CV, Carr MH. Antenatal fetal surveillance in pregnancies complicated by fetal
gastroschisis. Am J Obstet Gynecol 2008;198:
686.e1-5.
93. Vegunta RK, Wallace LJ, Leonardi MR, et al.
Perinatal management of gastroschisis: analysis
of a newly established clinical pathway. J Pediatr
Surg 2005;40:528-34.

1980 archive gastroschisis

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