O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 13 67% 5% 0% 0% 5% 7% 7% 2% 2% 2% 3% Kwazulu Natal is divided into 11 municipalities and the overwhelming majority of patients with the diagnosis resided in the Durban and surrounding areas (Fig 1). One patient was referred to IALCH from the Eastern Cape. Table 2: Abnormality detection for omphalocoele and gastroschisis groups (n=59). Investigation Number (%) Concordancy of ultrasound diagnosis to diagnosis at birth Yes 58 (98.3) No 1 (1.7) Concordancy of antenatal diagnosis to diagnosis at birth Omphalocoele 24 (40.7) Gastroschisis 35 (59.3) Other associated congenital abnormalities on ultrasound Yes 10 (17) No 49 (83) Con rmed congenital defect post delivery Omphalocoele 25 (42.3) Gastroschisis 34 (57.6) Amniocentesis was performed in 14/59 cases (23.7%) with 11 cases forming part of the omphalocoele group and 3 cases in the gastroschisis group. No aneuploidy was detected in any of those patients but 1 result was unknown. At delivery, however, 2 cases of aneuploidy were diagnosed, one omphalocoele case with trisomy 21 and the other a gastroschisis case with trisomy 18 (this case with gastroschisis had other associated anomalies). As noted in Table 2, in 58 out of 59 pregnancies (98%) the foetal AAWD defect could be correctly identi ed antenatally with ultrasound. In terms of the prenatal diagnosis, only one case was mistakenly diagnosed as gastroschisis on prenatal ultrasound, whereupon delivery a ruptured omphalocoele was apparent. Other associated structural anomalies on ultrasound were noted in 2 cases in the gastroschisis group and 8 cases in the omphalocoele group. Table 3: Neonatal birth data for gastroschisis and omphalocoele groups (n=59). Variable Mean ±SD Minimum Maximum 95%CI Age (years) 35.7±2.6 28 40 35.0-36.4 Median 36 Term 29 (49) Preterm 30(50.8) Mode of delivery Caesarean delivery 26 (44.06) Emergency C/S 12 (20.3) Elective C/S 9 (15.2) Spontaneous vaginal delivery 6 (10.2) Indication for C/S Growth restriction + foetal anomaly 3 (5.6) Twin pregnancy+ foetal anomaly 3 (5.6) Previous caesarean section x 2 2 (3.7) Previous caesarean section x 1 2 (3.7) Foetal anomaly 27(50.0) PROM + foetal anomaly 2 (3.7) Foetal distress 5(9.3) Preeclampsia+ foetal anomaly 1 (1.9) Foetal anomaly + MSL 3 (5.6) Anhydramnios 4(7.4) Multiple congenital anomalies 1 (1.9) All patients in this study were delivered at the institution. Table 3 shows that the average gestational age of delivery was 35.7 weeks (±2.6, 95% CI 35.0-36.4). Just over y percent of neonates were delivered pre-term (<37 weeks gestation). e preferred mode of delivery was via Caesarean section (90%) with the most common indication for Caesarean section being the foetal anomaly concerned (50%). Table 4: Ultrasound ndings for omphalocoele and gastroschisis groups. Variable Gastroschisis (34) Omphalocoele (25) Polyhydramnios 6 (17.6%) 7 (28%) Reduced liquor/ Anhydramnios 7 (20.5%) 2 (8%) No bowel dilatation 16 (47%) 0 (0%) Extra-abdominal bowel dilatation 15 (44%) 0(0%) Intra-abdominal bowel dilatation 3 (8.8%) 0(0%) Bowel thickening 1 (2.9%) 0(0%) IUGR 9 (26%) 1 (4%) Herniation of abdominal organs (stomach/liver) 3 (8.8%) 14 (56%) Distended stomach (intra-abdominal) 4 (11.8%) 0(0%) In terms of the ultrasound ndings (Table 4), bowel dilatation (extra or intra-abdominal) was present in 50% of the gastroschisis group and liquor abnormalities (polyhydramnios/ reduced liquor/ anhydramnios) were detected in 38%. Using the Fisher’s exact tests, neither bowel dilatation, nor liquor volume abnormalities had any signi cant e ect on outcomes (surgery/ ventilation/days to oral feed/hospital stay and mortality) in the gastroschisis group. ere was only one case noted to have bowel thickening in the gastroschisis group (2.9%) and 21% were observed to either have a distended stomach or stomach herniation. Table 5: Demographic and patient characteristics (n=59). Data are reported as mean ± SD, median and frequencies. Variable Total Number 59 (%) Omphalocoele (n=25) Gastroschisis (n=34) p value Surgery Yes 42 (71.2) 12 (48) 30 (88) 0.004 No 17 (28.8) Ventilation Yes 36 (61) 9 (36) 27 (79.4) 0.001 No 23 (39) Days to rst oral feed (days) Mean 6.9±9.3 3.4 ±8.3 9.6±9.2 0.01 Median 3 Range 0 – 41 Length of hospital stay (days) Median 8 4 12.5 0.001 Range 0 – 67 Cause of neonatal death Sepsis 8 (13.5%) O&G Forum 2022; 32: 11-16 ORIGINAL RESEARCH