ADVERSE OUTCOME AFTER PRENATAL-DIAGNOSIS OF GASTROSCHISIS - THE ROLE OF FETAL MONITORING

Fifty-seven fetuses with gastroschisis presented between 1982 and 1995 were studied by retrospective review of medical records. There were t hree late intrauterine deaths (IUD). Fetal distress, as determined by reduced fetal movements or abnormal cardiotopograph (CTG), was encount ered in 23 of the 54 liveborn infants (43%), all of whom had delivery expedited either by emergency caesarean section (n = 19) or induction (n = 4). Six infants had abnormal neurological outcome: two died in th e neonatal period of severe perinatal brain injury, neonatal fits were observed in four, two of whom developed cerebral palsy, and one died at the age of 7 years. All six of these infants had suffered fetal dis tress, If the three intrauterine deaths are included, 16% of all cases were associated with abnormal neurological outcome. The introduction of regular CTG monitoring from 32 weeks' gestation in 1990 increased t he ability to detect fetal distress twofold, This resulted in a simila r increase in obstetric intervention and an associated reduction in ad verse neurological outcome. Pregnancies associated with gastroschisis should be considered at significant risk of fetal distress, which itse lf may culminate in late intrauterine death, neonatal death, or advers e neurological outcome, Careful, repeated fetal monitoring in the thir d trimester is indicated. Copyright (C) 1997 by W.B. Saunders Company.