Madazli Riza, Kaymak Didem, Arıca Görkem, Başıbüyük Zafer, Alıcı Davutoğlu Ebru, Alp Ünkar Zeynep
Department of Obstetrics and Gynecology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.
Department of Neonatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.
J Turk Ger Gynecol Assoc. 2024 Aug 29;25(3):152-158. doi: 10.4274/jtgga.galenos.2023.2023-6-10.
To evaluate the clinical features and perinatal outcomes of antenatally diagnosed fetuses with omphalocele and gastroschisis.
This was a retrospective, single-center, cohort study of prenatally diagnosed fetuses with omphalocele and gastroschisis followed-up and delivered at a university hospital. Demographic, pregnancy, birth and perinatal outcomes were compared between gastroschisis and omphalocele.
A total of 75 fetuses with omphalocele and 21 cases with gastroschisis were evaluated. The mean maternal age of women carrying a fetus with omphalocele was significantly higher than the women with gastroschisis (p=0.001). Associated structural anomalies were found in 53.3% and 4.7% of fetuses with omphalocele and gastroschisis, respectively (p<0.001). The rate of chromosomal anomaly was 8.3% in pregnancies with omphalocele. In liveborn pregnancies, the mean gestational age at delivery and birth weight did not differ between the study groups. Time to postoperative oral intake, duration of parenteral nutrition and length of hospital stay were significantly longer in babies with gastroschisis than omphalocele (p<0.01). Rates of termination, intrauterine, neonatal and infant death of fetuses with omphalocele were 25.3%, 6.7%, 10.7% and 2.7% respectively. Time to postoperative oral intake, duration of parenteral nutrition and duration of hospitalization were significantly longer in babies with complex compared to simple gastroschisis (p<0.01). Survival rates were 95.2%, 82.9% and 20% in fetuses with gastroschisis, isolated and non-isolated omphalocele, respectively.
Associated structural and chromosomal anomalies were significantly more common in fetuses with omphalocele compared to those with gastroschisis. Prognosis of fetuses with omphalocele depended on the associated structural and chromosomal anomalies, whereas bowel compromise was the main determining factor in gastroschisis.
评估产前诊断为脐膨出和腹裂的胎儿的临床特征及围产期结局。
这是一项回顾性、单中心队列研究，研究对象为在某大学医院接受随访并分娩的产前诊断为脐膨出和腹裂的胎儿。比较腹裂和脐膨出胎儿的人口统计学、妊娠、出生及围产期结局。
共评估了75例脐膨出胎儿和21例腹裂胎儿。携带脐膨出胎儿的孕妇平均年龄显著高于腹裂孕妇（p = 0.001）。脐膨出和腹裂胎儿中分别有53.3%和4.7%伴有其他结构异常（p<0.001）。脐膨出妊娠中染色体异常率为8.3%。在活产妊娠中，各研究组的平均分娩孕周和出生体重无差异。腹裂患儿术后开始经口进食的时间、肠外营养持续时间及住院时间均显著长于脐膨出患儿（p<0.01）。脐膨出胎儿的终止妊娠率、宫内死亡率、新生儿死亡率和婴儿死亡率分别为25.3%、6.7%、10.7%和2.7%。与单纯腹裂患儿相比，复杂腹裂患儿术后开始经口进食的时间、肠外营养持续时间及住院时间均显著延长（p<0.01）。腹裂、孤立性脐膨出和非孤立性脐膨出胎儿的存活率分别为95.2%、82.9%和20%。
与腹裂胎儿相比，脐膨出胎儿伴有结构和染色体异常的情况明显更为常见。脐膨出胎儿的预后取决于相关的结构和染色体异常，而肠损伤是腹裂的主要决定因素。
