Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin,
Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Fetal Diagn Ther. 2019;45(2):125-130. doi: 10.1159/000487541. Epub 2018 May 23.
Gastroschisis is an abdominal wall defect with increasing incidence. Given the lack of surveillance guidelines among maternal-fetal medicine (MFM) specialists, this study describes current practices in gastroschisis management.
An online survey was administered to MFM specialists from institutions affiliated with the North American Fetal Therapy Network (NAFTNet). Questions focused on surveillance timing, testing, findings that changed clinical management, and delivery plan.
Responses were obtained from 29/29 (100%) NAFTNet centers, comprising 143/371 (39%) providers. The majority had a regimen for antenatal surveillance in patients with stable gastroschisis (94%; 134/141). Antenatal testing began at 32 weeks for 68% (89/131) of MFM specialists. The nonstress test (55%; 72/129), biophysical profile (50%; 63/126), and amniotic fluid index (64%; 84/131) were used weekly. Estimated fetal weight (EFW) was performed monthly by 79% (103/131) of providers. At 28 weeks, abnormal EFW (77%; 97/126) and Doppler ultrasound (78%; 99/127) most frequently altered management. In stable gastroschisis, 43% (60/140) of providers delivered at 37 weeks, and 29% (40/ 140) at 39 weeks.
Gastroschisis management differs among NAFTNet centers, although the majority initiate surveillance at 32 weeks. Timing of delivery still requires consensus. Prospective studies are necessary to further optimize practice guidelines and patient care.
腹裂是一种腹壁缺陷，发病率不断上升。鉴于母胎医学（MFM）专家缺乏监测指南，本研究描述了腹裂管理的当前实践。
向隶属于北美胎儿治疗网络（NAFTNet）的机构的 MFM 专家进行了在线调查。问题集中在监测时机、检测、改变临床管理的发现以及分娩计划上。
从 29 个（100%）NAFTNet 中心获得了回应，其中包括 143 个（39%）提供者。大多数有稳定腹裂患者的产前监测方案（94%；134/141）。68%（89/131）的 MFM 专家在 32 周开始进行产前检查。55%（72/129）、生物物理概况（50%；63/126）和羊水指数（64%；84/131）每周进行一次。79%（103/131）的提供者每月进行估计胎儿体重（EFW）。在 28 周时，异常 EFW（77%；97/126）和多普勒超声（78%；99/127）最常改变管理。在稳定的腹裂中，43%（60/140）的提供者在 37 周分娩，29%（40/140）在 39 周分娩。
尽管大多数中心在 32 周开始进行监测，但腹裂的管理在 NAFTNet 中心之间存在差异。分娩时机仍需达成共识。需要前瞻性研究进一步优化实践指南和患者护理。
