gastroschisis l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Gastroschisis PowerPoint Presentation
Download Presentation
Gastroschisis

Loading in 2 Seconds...

play fullscreen
1 / 23

Gastroschisis - PowerPoint PPT Presentation


  • 1118 Views
  • Uploaded on

Gastroschisis March 22nd, 2006 EOPC Journal Club Article Source Clinical Obstetrics and Gynecology Volume 48 Number 4 December 2005 Saada, Julien M.D. et al… Paris, France Introduction Definition - Abdominal wall defect Right side of umbilicus Absence of membrane

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Gastroschisis' - Audrey


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
gastroschisis

Gastroschisis

March 22nd, 2006

EOPC Journal Club

article source
Article Source
  • Clinical Obstetrics and Gynecology
    • Volume 48
    • Number 4
    • December 2005
    • Saada, Julien M.D. et al…
    • Paris, France
introduction
Introduction
  • Definition -
    • Abdominal wall defect
    • Right side of umbilicus
    • Absence of membrane
    • Prolapsed bowel loops in amniotic fluid
introduction4
Introduction
  • Diagnosis
    • Prenatal
    • Sonography
  • Prognosis
    • 90% survival
  • Morbidity
    • Associated factors
introduction5
Introduction
  • Pathogenesis
    • No definite answer yet
  • Management
    • Debated: mode, time and place of delivery
  • Recent Advances
    • Amnioexchange
        • Prevent Inflammation & exposure to digestive compounds
prevalence epidemiology
Prevalence/Epidemiology
  • Total: 1-4/10,000 live births
  • Sex ratio of 1
  • Global increase: unknown reason
prevalence epidemiology7
Prevalence/Epidemiology
  • Risk factors
    • Maternal:
      • Age <25
      • Age <20 = 4 times increase
      • Primiparas
      • Low socioeconomic status
      • Drug abuse (Tobacco, EtOH, cocaine)
      • Teratogens
    • Genetic: trisomy 13, 18, & 21; monosomy 22
pathogenesis
Pathogenesis
  • Premature regression
    • 5th - 6th weeks of right omphalomesenteric artery/vein
    • Failure of mesodermal components
    • Intestinal malrotation
    • Addition hypothesis-
      • Early in utero rupture of umbilical cord hernia
pathogenesis10
Pathogenesis
  • Associated Bowel Lesions -
    • Animal model studies show mechanical and chemical causes
    • Amniotic fluid: sterile inflammation
    • SMA compression
diagnosis sonography
Diagnosis/Sonography
  • 2nd Trimester

Ultrasound

Showing

Defect lateral to the

Umbilical cord

diagnosis sonography13
Diagnosis/Sonography
  • Chromosomal abnormalities / Extra-intestinal malformations
  • Determine Bowel Wall thickness
    • Controversial
  • Intraabdominal Bowel Dilation
  • Mesenteric vascularization
    • Doppler of SMA
diagnosis sonography14
Diagnosis/Sonography
  • Associated Malformation:
    • Hydronephrosis
    • Arthrogryposis
    • Hypoplastic gallbladder
    • Meckel diverticulum
    • Oligo-anhydramnios (intrauterine growth restriction)
      • Table 4 of article
fhr monitoring
FHR Monitoring
  • Abnormalities seen in 3rd trimester
    • May require delivery
    • Decreased variability with or without decels.
    • Result from torsion/IUGR/Oligohydramnios
  • 3rd Trimester cardiotocography
    • FHR monitoring associated with reduction in neurological complications
fetal therapy
Fetal Therapy
  • Amnioinfusion: injection of warmed physiological saline
  • Amnioexhange: replacement of warm saline with 1:1 volume exchange.
  • Need retrospective/prospective study
time mode and place
Time, Mode and Place
  • Mean gestational age 36 - 37 weeks
  • Cesarean versus vaginal
  • Preterm delivery (< 36 weeks)
    • No advantage - increase time to feed and increase LOS
  • Location - pediatric surgical facilities
time mode and place18
Time, Mode and Place
  • Trends in mode of delivery for gastroschisis infants. Snyder CL, St Peter SD.

Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.

“16% per year increase in the chance of cesarean delivery. There has been a significant trend toward cesarean delivery in patients with gastroschisis treated at our institution.”

time mode and place19
Time, Mode and Place
  • Mode of Delivery and Neonatal Survival of Infants With Isolated Gastroschisis
  • Hamisu M. Salihu, Obstet Gynecol 2004;104:678–83.
  • In this study the mode of delivery was not found to be associated with neonatal survival of infants with gastroschisis. Preterm birth rather than small for gestational age was the predictor of neonatal death among gastroschisis infants.
postnatal care
Postnatal Care
  • Surgical Treatment: Primary Closure vs Silo

Group I (Surgery) Group II (Silo) P Values

No. of Patients 39 26

Days on ventilator (median) 4 (3-6) 1 (1-2) <0.0001

Days until first feeding 21 +/- 3 11 +/- <0.01

Days until full feeding 34 +/- 4 19 +/- 2 <0.006

No. receiving paralytics 23 2 <0.0001

NEC episodes 7 2 0.7*

Central line infections 19 3 <0.003

Maximum bilirubin 7.0 4.5 <0.03

Days with central line 39 +/- 4 27 +/- 3 <0.05

Reoperations 12 (31%) 4 (15%) 0.24*

Days in hospital 40 (24-60) 28.5 (25-42.3) <0.2*

*P values < 0.05 considered significant

Schlatter, et al; Journal of Pediatric Surgery, Vol. 38, No. 3, 2003: pp 459-464

Slide taken from Hebertson/Newhouse presentation 2-2006

postnatal care21
Postnatal Care
  • Primary versus delayed closure
    • Dependent on intraabdominal pressure
    • Use of spring loaded silo associated with improved outcome
  • Progressive replacement of parenteral nutrition by enteral nutrition.
prognosis
Prognosis
  • Prognosis is dependent mainly upon severity of associated problems
    • Prematurity
    • Intestinal atresia
    • Short gut
    • Intestinal inflammatory dysfunction
  • Prognosis has improved because of maternal ultrasound diagnosis and monitoring
  • Much improved since the advancements in IV nutrition with subsequent conversion to enteral feeds
prognosis23
Prognosis
  • Survival rates of 90 %
    • Improved due to prenatal diagnosis
  • Dependent upon -
    • Ventilation
    • Parenteral to enteral nutrition time
  • Overall LOS = 80 days
  • Improved long-term outcomes