O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 11 Introduction Gastroschisis and omphalocoele represent the two most common anterior abdominal wall defects 1,2,3,4 . Omphalocoele consists of evisceration of abdominal contents into a sac at the base of the umbilical cord while gastroschisis is a para-umbilical defect resulting in free oating loops of bowel and occasionally, organs in the amniotic uid 3 . Gastroschisis is thought to be caused by an ischaemic insult to the developing body wall and has a strong association with young maternal age. Omphalocoele, on the other hand, is presumed to involve failure of abdominal wall infolding and is associated with advancedmaternal age 4 . Gastroschisis in 90% of cases is an isolated lesion, whilst omphalocoele is o en found in conjunction with other structural defects as well as aneuploidy in up to 50% of cases necessitating karyotyping 4,5 . Raised maternal serum levels of alpha feto-protein (AFP) can detect more than 99% of gastroschisis and 78% of omphalocoele, with a false positive rate of 5.3% 6 . In the public sector in South Africa serum screening for birth defects is not available making ultrasound the only screening tool for structural abnormalities. Both gastroschisis and omphalocoele can be detected at the rst trimester nuchal translucency scan but are more o en identi ed during a second trimester anomaly scan. 5 e prenatal diagnosis of these structural abnormalities enables the clinician to identify the pregnancy as high risk and assessments of speci c ultrasound parameters can be performed to prognosticate outcomes for these infants. With regards to gastroschisis, studies have looked at bowel dilatation, bowel thickening, stomach dilatation and growth restriction as possible outcome predictors. e early detection of malformations a ords parents the opportunity to prepare for the birth in a tertiary centre with appropriate neonatal intensive care and surgical facilities as well as mentally prepare for any complications which can include death of the infant. 7 Termination of the pregnancy may be advised in cases where aneuploidy is revealed or multiple abnormalities are detected on prenatal ultrasound 2 . Di erentiating between omphalocoele and gastroschisis is important as the prognosis for each is di erent as O&G Forum 2022; 32: 11-16 ORIGINAL RESEARCH Correspondence Prof Ismail Bhorat email: bhorat@worldonline.co.za A retrospective analysis of fetuses diagnosed with anterior abdominal wall defects in a Tertiary Referral South African Hospital Setting Dr Valsura Ramsundar 1 , Prof Ismail Bhorat 2 1 Department of Obstetrics and Gynaecology, University of Kwa-Zulu Natal, Durban, South Africa 2 Sub Department of Fetal Medicine, Department of Obstetrics and Gynaecology, University of Kwa-Zulu Natal, Durban, South Africa Abstract Background : Gastroschisis and omphalocoele are the two most common congenital anterior abdominal wall defects. Complications of these defects can be minimised if a prenatal diagnosis is made by allowing for the opportunity to alter the mode, location, and timing of delivery and to plan postnatal intervention. Objectives: A retrospective analysis of fetuses diagnosed with anterior abdominal wall defects in a tertiary referral South African hospital setting. Methods: This was a retrospective descriptive study performed at Inkosi Albert Luthuli Central Hospital, Durban from January 2010 to December 2018.After exclusion criteria, electronic chart review of 59 live born babies diagnosed with either gastroschisis or omphalocoele was undertaken. Results: Fifty six singleton pregnancies and 3 twin pregnancies were reviewed comprising 25 cases of omphalocoele and 34 cases of gastroschisis. In the gastroschisis set liquor abnormalities (38%) and bowel dilatation (50%) were noted but were not predictive of an adverse outcome. In the omphalocoele group, liquor abnormalities were found in 36% of cases, of which 44% resulted in mortality. Neonates with gastroschisis remained hospitalised longer than neonates with an omphalocoele (12 vs 4 days).Although the mortality rate was higher in the omphalocoele compared to the gastroschisis group, this was not statistically significant (32% vs 14.7%; p value=0.11). Conclusion : The overall survival of neonates born with gastroschisis was 85% despite longer hospitalisation and parenteral nutrition compared to infants with omphalocoele (68% survival).With regards to gastroschisis, bowel dilatation and liquor volume abnormalities were not predictive of adverse outcomes in this study.