PRENATAL-DIAGNOSIS OF FETAL ABDOMINAL-WALL DEFECTS - A RETROSPECTIVE ANALYSIS OF 44 CASES

Forty-four fetal abdominal wall. defects, consisting of 31 omphalocoel es, 11 cases of gastroschisis, and two body stalk anomalies (which are excluded from further analysis), were diagnosed at 12-39 weeks (media n 26 weeks) of gestation. In 10/31 (32 per cent) cases of omphalocoele and in 4/11 (36 per cent) cases of gastroschisis, multiple congenital anomalies were diagnosed. A normal amount of amniotic fluid was prese nt in 39 cases; in three cases of omphalocoele an abnormal amount of a mniotic fluid (polyhydramnios, n=2; oligohydramnios, n=1) was seen. Pr enatally, intrauterine growth retardation (IUGR) was diagnosed in each type of anomaly only once, although the birth weight was below the te nth centile in 23 per cent of omphalocoeles and in 36 per cent of case s of gastroschisis. An abnormal prenatal karyotpye was established in 5/25 (20 per cent) cases of omphalocoele versus none in the gastroschi sis group. In 36 cases an expectant obstetric management was followed, and in six cases of omphalocoele the pregnancies were terminated beca use of severe multiple anomalies (n=3) or an abnormal prenatal karyoty pe (n=3). The preterm delivery rate (excluding terminations) was 12/25 (48 per cent) in the omphalocoele subgroup versus 8/11 (73 per cent) in the gastroschisis subgroup. The Caesarean section rate was almost i dentical (19 versus 18 per cent) in both subgroups; the majority (n=5) were performed to protect the abdominal wall defect. The overall surv ival rate was 39 per cent in the omphalocoele group; in all surviving infants this was the sole congenital anomaly and in each instance ther e was a normal karyotype. In the gastroschisis group, 8/11 (72 per cen t) infants survived, of which two children also displayed unilateral h ydronephrosis.