School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia.
J Matern Fetal Neonatal Med. 2021 Apr;34(8):1269-1276. doi: 10.1080/14767058.2019.1633303. Epub 2019 Jun 26.
In this study, we aimed to comprehensively evaluate risk factors, ultrasound estimation of fetal weight, prenatal management, and pregnancy outcomes of gastroschisis and omphalocele at a metropolitan Australian hospital.
This was a retrospective single-center cohort study from 2006 to 2014 at a tertiary hospital with colocated neonatal surgical facilities. Demographic, pregnancy, ultrasound, birth and neonatal data were compared between gastroschisis and omphalocele. Correlation between routine (Hadlock 1 &2) and specific (Siemer) estimated fetal weight (EFW) estimation formulae with birth weight (BW) was made for those 50 gastroschisis cases with ≥2 third trimester scans and last scan ≤2 weeks prior to birth.
There were 126 abdominal wall defects: 83 gastroschisis and 43 omphalocele. Consistent with international literature, the average maternal age was lower for gastroschisis and rates of smoking higher, while there were more intrauterine deaths and pregnancy terminations in omphalocele. Gastroschisis mothers were more likely living outside Sydney, had more infections in pregnancy and were followed with a larger number of antenatal visits, with a shorter period from the last visit to birth. In omphalocele pregnancies, amniocentesis was more likely performed, with more abnormal results than in gastroschisis fetuses. All EFW formulae had a good correlation between Z score for the last US and actual BW (ICC 0.693-0.815), with Hadlock 2 being the best. Siemer formula had the best correlation from first to the last scan. Gastroschisis newborns were born earlier (36.8 versus 38.2 wks = .001), with smaller birthweight (2.52 versus 3.03 kg, < .001), a longer request of intensive care (central line, parenteral nutrition, intubation) and second surgery, along with more multisystem complications (average 1.5 versus 0.7, = .004) and a longer hospital stay (58.8 versus 36.8 d, < .001).
Demographic, antenatal, and pregnancy outcome data for abdominal wall defects correlated well with the international literature. Hadlock 1-2 gave the most consistent EFW estimate, with all formulae showing good correlation.
本研究旨在综合评估澳大利亚大都市一家医院的腹裂和脐膨出的危险因素、胎儿体重的超声评估、产前管理和妊娠结局。
这是一项 2006 年至 2014 年在一家拥有新生儿外科设施的三级医院进行的回顾性单中心队列研究。比较了腹裂和脐膨出的人口统计学、妊娠、超声、分娩和新生儿数据。对 50 例至少有 2 次妊娠晚期扫描且最后一次扫描在出生前 2 周内的腹裂病例，比较了常规（Hadlock 1&2）和特定（Siemer）估计胎儿体重（EFW）公式与出生体重（BW）的相关性。
共有 126 例腹壁缺陷：83 例腹裂和 43 例脐膨出。与国际文献一致，腹裂患者的平均母亲年龄较低，吸烟率较高，而脐膨出患者的宫内死亡率和妊娠终止率较高。腹裂母亲更有可能居住在悉尼以外的地方，在妊娠期间有更多感染，并接受更多的产前检查，从最后一次就诊到分娩的时间更短。在脐膨出妊娠中，羊膜穿刺术更有可能进行，且胎儿异常结果的比例高于腹裂胎儿。所有 EFW 公式在末次 US 的 Z 评分与实际 BW 之间均具有良好的相关性（ICC 0.693-0.815），其中 Hadlock 2 最好。Siemer 公式从第一次到最后一次扫描的相关性最好。与脐膨出新生儿相比，腹裂新生儿出生更早（36.8 周 vs. 38.2 周，=0.001），出生体重更小（2.52 千克 vs. 3.03 千克，<0.001），需要更长时间的重症监护（中央静脉置管、肠外营养、插管）和二次手术，且多系统并发症更多（平均 1.5 例 vs. 0.7 例，=0.004），住院时间更长（58.8 天 vs. 36.8 天，<0.001）。
腹壁缺陷的人口统计学、产前和妊娠结局数据与国际文献相符。Hadlock 1-2 提供了最一致的 EFW 估计值，所有公式均显示出良好的相关性。
