O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 14 Ruptured omphalocoele 1 (1.7%) Suspected chromosomal abnormality 2 (3.4%) Severe birth asphyxia 1 (1.7%) Non-viable necrotic bowel 1 (1.7%) Post-delivery outcomes can be observed in Table 5. Primary surgical repair was performed in 71% (42/59) of the cases. irteen neonates in the omphalocoele subset and four in the gastroschisis subset did not undergo surgery. ere was a signi cant association between surgery and the two groups (p=0.004) with the gastroschisis group more likely to require surgical intervention compared to the omphalocoele group. Table 6: Final Outcome for the omphalocoele and gastroschisis groups (n=59). Alive ENND LNND Infant Death Total Twin pregnancy 1 1 1 - 3 Singleton pregnancy 45 4 4 3 56 Total 46 (78%) 5 (8.5%) 5 (8.5%) 3 (5%) 59 Subgroup Analysis Gastroschisis (N=34) Omphalocoele (N=25) p-value Alive 29 (85.2%) 17 (68%) Demised 5 (14.7%) 8 (32%) 0.11 e majority of babies born with gastroschisis were simple and only 2 cases were complicated by intestinal atresia, both of which survived. Of the 2 cases with complex gastroschisis only 1 foetus had bowel dilation which was both intra and extra- abdominal. Forty percent (10/25) of the omphalocoele group were found to be non-isolated cases at delivery with 3 suspected cases of Beck-with Wiedemann syndrome, 4 displaying dysmorphism, 2 structural defects and one con rmed Down syndrome. Polyhydramnios and omphalocoeles containing liver were more likely to be associated with non-isolated cases. e overall survival rate in this study was 78% (Table 6), with the gastroschisis group faring better than the omphalocoele group. Discussion is study examines the outcomes of 59 cases of antenatally diagnosed anterior abdominal wall defects. Overall, the survival rate of antenatally diagnosed omphalocoele was 68% (17/25), with a comparatively better survival rate of 85% (29/34) in the gastroschisis group which is possibly due to the lack of associated anomalies in neonates with gastroschisis. Given the broad spectrum of potential outcomes, the hypothesis is that the identi cation of prenatal outcome predictors will not only improve the accuracy of prenatal counselling but also help to identify patients that may bene t from closer foetal surveillance and determine optimal timing of delivery .9 e vast majority of foetal abnormalities occurs in low- risk populations, which has resulted in ultrasound screening programmes being o ered routinely as part of antenatal care to all pregnant women. 1 European studies conducted in 2001 revealed prenatal ultrasound detection rates of gastroschisis and omphalocoele to be 83% and 75% respectively. 7 is study only focussed on ultrasound reports that were attached to thematernal record. Cases referred without an ultrasound report or prenatal diagnosis were excluded and therefore an overall detection rate for AAWD in this study could not be determined. is study did however reveal a 98% concordance between prenatal ultrasound nding and the postnatal diagnosis. According to the ndings the one case that was not diagnosed was reported as an echogenic cord cyst when in actual fact an omphalocoele was present. Incidence rates of gastroschisis have increased over the last 30 years. 5 e incidence of omphalocoele ranges between 1.5 and 3 per 10,000 births and has remained stable. 2 Out of the 59 cases of AAWD in this study, gastroschisis was the more common defect seen at IALCH. Interestingly, none of the patients admitted to using tobacco, alcohol or other substances which is hypothesised to be linked to the aetiology of gastroschisis. 2 It was established that two thirds of AAWD were from the Ethekwini region and, being a more urban industrialised area, it is possible that dietary factors or environmental toxins may be contributing factors. It is known that gastroschisis is associated with young maternal age. 5 Sixty four percent (64%) of the study population were under the age of 25. Furthermore, patients who delivered with gastroschisis were signi cantly younger compared to patients who delivered infants with omphalocoele (22±6.5 vs 27.6±8.7; p<0.007). is is in keeping with the well-known associations with young maternal age and gastroschisis. 5 e incidence of abdominal wall defects was associated with age group, mainly due to an inverse association with gastroschisis (p<0.0001). Omphalocoele is known to be linked to advanced maternal age. 5 However in this study only 13% of patients were over the age of 35 and, more surprisingly, this comprised only one third of the omphalocoele set. e only variable that could give rise to this discordancy is possibly the large number of immunocompromised mothers in the omphalocoele group, although no studies have speci cally addressed HIV and the risk of ventral wall defects. It is unknown if the antiretroviral drugs may contribute to the increased incidence of omphalocoele in the younger age groups. Only 11/25 cases in the omphalocoele group underwent genetic screening in the form of amniocentesis despite there being high associations with chromosomal abnormalities. 10 is displays clear underutilisation of genetic services and could be due to patient refusal. One baby in the omphalocoele group was con rmed as having Trisomy 21 at birth and 2 others that su ered early neonatal deaths were suspected of having chromosomal abnormalities. Ideally, the earlier the diagnosis of an abnormality is made, the better the management in terms of adequate counselling and ensuring maternal and foetal wellbeing. 8,11 All the patients in this study were diagnosed in the second trimester and majority only had one scan performed during the antenatal period. Intrauterine growth restriction (IUGR) is associated with gastroschisis in 25% of patients and in 5-35% of patients with omphalocoele. 2 is complication was found in 9 (26%) cases in the gastroschisis group and 1 (4%) case in the omphalocoele group, which was is in keeping with the established ndings of ventral wall defects. Nicholas et al found IUGR a signi cant predictor for adverse neonatal outcome with gastroschisis. 4 According to the analysis of the data in this study, growth restriction as well as liquor volume abnormalities (polyhydramnios/reduced liquor/ anhydramnios) were not found to be predictive of outcomes. O&G Forum 2022; 32: 11-16 ORIGINAL RESEARCH