A DECADE OF GASTROSCHISIS IN THE ERA OF ANTENATAL ULTRASOUND

Background: Gastroschisis is an uncommon condition in which viscera pr otrude at the base of the umbilical cord. To investigate the possible relationships between antenatal ultrasound findings, patient demograph ics, smoking, alcohol consumption and this condition, 21 causes are re viewed. Methods: The medical records and antenatal ultrasounds of 21 c hildren diagnosed with gastroschisis at the Adelaide Children's Hospit al between 1 January 1985 and 31 December 1992 were reviewed. Results: antenatal ultrasound was employed in 15 cases, and the diagnosis was accurately made in 13 (86.7%) of these. There were 17 live births, two elective terminations and two pre-term abortions. Seven of the 21 cas es had associated anomalies. The anomalies included five atresias, a v entricular septal defect (VSD), and a dislocated gall-bladder. Postope rative complications (which included one death) occurred in seven of t he 17 patients. Bowel dilatation or thickening was first detected on f ive ultrasound examinations performed before 21 weeks' gestation, and four ultrasounds after 21 weeks. The nine cases with bowel changes on ultrasound were associated with a high atresia rate and a longer hospi tal stay, but not with an increased complication rate. Maternal race, parity, and alcohol consumption were not associated with increased ris k of fetal gastroschisis. All mothers were under 27 years of age. Ther e were nine mothers who smoked during pregnancy and a disproportionate number of mothers who lived outside the metropolitan area with gastro schisis-affected offspring. Conclusions: Bowel changes seen on antenat al ultrasound increase the chances of intestinal atresia and longer ho spitalization. Smoking during pregnancy may be associated with an incr eased risk of gastroschisis.