GASTROSCHISIS - CAN ANTENATAL ULTRASOUND PREDICT INFANT OUTCOMES

Objective: To test previously proposed but unproven antenatal ultrasou nd prognostic criteria in fetal gastroschisis. Methods: Thirty consecu tive gastroschisis-affected pregnancies and their outcomes were review ed retrospectively. Data were tabulated by review of antenatal ultraso und videotapes, with blinded comparison to indicators of short- and lo ng-term infant outcomes obtained from the medical records. Criteria of previous reports were applied to these data, focusing on their abilit y to prognosticate effectively. Results: Applying a criterion of 10 mm bowel dilatation proved minimally useful in prognosticating infant ou tcomes. However, a stricter 17-mm criterion for clinically important b owel dilatation provided prognostic information, with remarkable impro vement in specificity (75 versus 37%) and positive predictive value (5 5 versus 37%) for infant morbidity, with comparatively little loss of sensitivity (71 versus 85%). Conclusions: Bowel dilated more than 17 m m on antenatal ultrasound appears to be associated with increased shor t- and long-term infant morbidity. Whether this finding warrants obste tric intervention in the preterm gastroschisis-affected pregnancy with substantial bowel dilatation remains to be determined.