Oct 6, 2013 - Conclusions: Inversion of the pyramid of prenatal care is providing ... Opening of the uterine isthmus at 11â13 weeks' gestation is not related to ...
23rd World Congress on Ultrasound in Obstetrics and Gynecology
Short oral presentation abstracts
OP01.07 Prenatal diagnosis of congenital diarrhea using color Doppler ultrasonography
OP01.09 The outcome of gastroschisis as influenced by the timing of prenatal diagnosis: a single hospital experience
Y. Mano, H. Tsuda, S. Sumigama, T. Kotani, F. Kikkawa
R. Findlay, P. Coombs, M. Teoh
Nagoya University School of Medicine, Nagoya, Japan
Monash Health, Melbourne, VIC, Australia
Congenital chloride diarrhea (CCD) is a rare disease caused by malabsorption of chloride in the ileum and colon. Delays in treatment lead to poor prognoses; however, the condition is often misdiagnosed as obstructive bowel disease. We describe, for the first time, prenatal diagnosis of fetal diarrhea using color Doppler ultrasonography. A 32-year-old Japanese female, gravida 2, para 2, was referred to our hospital at 31 + 6 weeks of gestation on suspicion of fetal bowel obstruction. An ultrasound examination showed marked polyhydramnios (amniotic fluid index; 41) and a dilated fetal bowel that exhibited a honeycomb appearance. The patient was hospitalized, and amnioreduction was performed at 32 + 3 weeks of gestation. The magnetic resonance imaging revealed diffusely dilated bowel loops that led to the colon and rectum. Amnioreduction was repeated 3 times due to recurring polyhydramnios. Then, on suspicion of congenital diarrhea, we performed color Doppler to detect fetal diarrhea and ultimately observed a unidirectional flow from the fetal anus to the amniotic cavity. At 37 + 0 weeks of gestation, the patient went into spontaneous labor and delivered a 3,092-g male baby vaginally at 37 + 1 weeks of gestation. The neonate had a distended abdomen and yellow watery diarrhea immediately after birth. The sodium and chloride concentrations of the stool were 136 and 147 mmol/L, respectively; thus, the diagnosis of CCD was confirmed (chloride concentration: >90mmol/L).
Objectives: Gastroschisis is a congenital anterior wall defect associated with considerable morbidity. There is limited understanding of its pathogenesis and the factors which affect prognosis. Particularly, the impact of the timing of diagnosis has not been studied previously. We hypothesized that the age of diagnosis in the context of specific ultrasound features such as the size of the externalised bowl mass would significantly influence perinatal outcome. Methods: A retrospective cohort of consecutive cases (44) of fetal gastroschisis referred to a tertiary centre was identified between 2005–2012. Of these, 6 patients were lost to follow up, termination of the pregnancy or excluded due to co-existing defects/genetic/chromosome abnormality. The remaining patients (n = 38) were stratified by age of diagnosis; 18weeks (18). The characteristics of the gastroschisis at this time of diagnosis were identified including the size of the defect and the presence of intra or extra bowel dilatation. The perinatal and pediatric course of these pregnancies was studied. Two of these patients were lost to fetal death in utero (FDIU), one from each group. Results: 38 patients were studied in the antenatal period and 36 in the neonate period. Prenatal ultrasound results show no significant difference between the two groups. Neonatal data of the age of delivery, mode of delivery, age at first operation on defect and the time of stay in hospital were similar between the two groups. There was a significant difference in the time to final surgery to close the defect with the 18wks group. The time to establishing full enteral feeds was also mildly different. The sepsis rates between the two groups was elevated in the
