engleski

Routine prenatal ultrasound disgnosis of omphalocele and gastroschisis in Europe

Evaluation of the prenatal diagnosis of gastroschisis and omphalocele by routine ultrasound examination of the fetus in unselected populations across Europe. Analysis of associated malformations, syndromes and chromosomal abnormalities and of their influence on the pregnancy outcome. We have used data from 19 Congenital Malformation Registries from 11 European countries. Registries collected data on the family history, mother, fetus/infant, results of prenatal scans and outcome of pregnancy. During the study period (01/07/96 to 31/12/98) there were 690,123 monitored pregnancies in the area covered. 243 cases of abdominal wall defects confirmed within one week after birth were included in the study. Prenatal detection rate was 75% (103/137) for omphalocele and 83% (88/106) for gastrochisis. There were significant regional variations in detection rates between European regions. Higher detection rates were observed in Western European countries with screening policy and lower rates in Eastern European countries and Western European countries without screening policy. The detection rate was significantly higher and the mean gestational age at detection lower in multiple affected fetuses. Associated malformations were found in 56.2 % (77/137) of omphalocele and 22.6 % (24/106) of gastroschisis. The overall survival rate was 41% (56) for omphalocele and 73% (62) for gastroschisis. A high number of cases resulted in fetal deaths (30 or 22% of omphalocele and 13 or 12% of gastroschisis). In 51 (37%) cases with omphalocele and in 31 (29%) with gastroschisis parents opted for termination of pregnancy (TOP). Proportion of TOP was higher in multiple affected fetuses compared with isolated cases. There is significant regional variation in the sensitivity of prenatal routine ultrasound in different European regions, reflecting differences in screening policies, equipment and levels of skill. A high proportion of abdominal wall defects is associated with malformations and/or chromosomal abnormalities that clearly influence perinatal outcome. A relatively high pregnancy termination rate is observed also in isolated cases with generally good prognosis after surgical correction.

prenatal ultrasound; gastroschisis; omphalocele

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