Raia-Barjat Tiphaine, Stadler Amandine, Varlet Marie-Noelle, Fanget Cécile, Noblot Edouard, Prieur Fabienne, Chauleur Céline, Varlet François
Department of Gynecology and Obstetrics, University Hospital, Saint Etienne, France; Research Unit EA3065 Saint - Etienne University Jean Monnet, F 42023 Saint Etienne, France.
Department of Gynecology and Obstetrics, University Hospital, Saint Etienne, France.
Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:116-20. doi: 10.1016/j.ejogrb.2016.05.045. Epub 2016 May 27.
Evaluate accuracy of prenatal ultrasound findings in predicting the risk of bowel atresia in patients with gastroschisis.
A retrospective study was conducted on 18 fetuses with a prenatal diagnostic of gastroschisis treated at University hospital of Saint Etienne France between 2002 and 2012. Ultrasound abnormalities were used to classify them into three groups: no ultrasound abnormality (n=4), oligohydramnios (n=9), intra-abdominal bowel dilatation ≥20.5mm (n=5). Postnatal outcomes were compared between groups. The threshold value of 20.5mm for the prediction of atresia was determined through the receiver operator characteristics curve.
In the group with oligohydramnios, intra uterine growth restriction were significantly more frequent (p=0.015) and three newborns had serositis including two with secondary complications after the initial surgery. In the group with major intra-abdominal bowel dilatation, all had a narrow defect <10mm significantly more than other fetuses (p=0.002). Intra-abdominal bowel dilatation reaching 20.5mm started at a mean gestational age significantly lower than that of the other fetuses (23.3 versus 29.7 weeks p=0.02). On the five fetuses presented intra-abdominal bowel dilatation ≥20.5mm, four showed atresia and no other newborn has this complication (p=0.0016). The threshold value of 20.5mm has a sensitivity of 100% and a specificity of 92.9%. The area under the curve was equal to 96.4%.
Intra-abdominal bowel dilatation ≥20.5mm seems to be associated with the risk of postnatal atresia. MRI could help to clarify a complicated or uncertain ultrasound aspect.
评估产前超声检查结果预测腹裂患儿肠道闭锁风险的准确性。
对2002年至2012年在法国圣艾蒂安大学医院接受治疗的18例产前诊断为腹裂的胎儿进行回顾性研究。根据超声异常情况将其分为三组：无超声异常（n = 4）、羊水过少（n = 9）、腹腔内肠管扩张≥20.5mm（n = 5）。比较各组产后结局。通过受试者操作特征曲线确定预测闭锁的20.5mm阈值。
羊水过少组中，宫内生长受限明显更常见（p = 0.015），3例新生儿发生浆膜炎，其中2例在初次手术后出现继发并发症。腹腔内肠管严重扩张组中，所有患儿均有狭窄缺损<10mm，明显多于其他胎儿（p = 0.002）。腹腔内肠管扩张达到20.5mm时的平均孕周明显低于其他胎儿（23.3周对29.7周，p = 0.02）。在腹腔内肠管扩张≥20.5mm的5例胎儿中，4例出现闭锁，其他新生儿无此并发症（p = 0.0016）。20.5mm的阈值敏感性为100%，特异性为92.9%。曲线下面积等于96.4%。
腹腔内肠管扩张≥20.5mm似乎与产后闭锁风险相关。磁共振成像有助于明确复杂或不确定的超声表现。
