Gastroschisis
Sherif Emil in Clinical Pediatric Surgery: A Case-Based Interactive Approach, 2019
Gastroschisis is one of the two major abdominal wall defects managed by pediatric surgeons. The role of the pediatric surgeon in managing babies with gastroschisis typically starts before birth when a mother carrying a fetus with gastroschisis is sent for prenatal consultation. The general concept is that the overall biophysical profile of the fetus and the findings specific to gastroschisis should be monitored closely. The dominant insult in gastroschisis is the non-fixation of the bowel and its prolonged exposure to amniotic fluid. Gastroschisis-associated atresia is a challenge as the bowel matting and inability to confirm distal patency often preclude a primary intestinal anastomosis on the first day of life. Closing gastroschisis may be suspected if intra-abdominal bowel dilatation is seen on ultrasound, in combination with a stable, dilating, or possibly shrinking extra-abdominal bowel mass. Long-term studies have demonstrated good quality of life in gastroschisis survivors.
Clinical Data to be Sent to the Pathologist: How Can the Obstetrician Ensure Optimal/Meaningful Pathologic Examination?
Ona Marie Faye-Petersen, Debra S. Heller, Vijay V. Joshi in Handbook of Placental Pathology, 2005
In an ideal world, all specimens sent to pathology would have adequate clinical information to evaluate each case appropriately. Information about the pregnancy should be given, including the mothers age, parity, week of gestation, and any problematic issues relating to the prenatal course or course of labor, such as oligohydramnios or fetal compromise, any significant maternal diseases, diagnostic or therapeutic interventions on the fetus or placenta during the pregnancy, and any abnormalities of the fetus/ neonate. Information of significance includes history of trauma, substance abuse, sexually transmitted disease, pertinent maternal serological studies, signs and symptoms on admission (e.g. preterm labor, premature rupture of membranes with duration), peripartum complications such as infections, abnormalities of fetal heart rate tracings, pertinent ultrasound findings such as position, any anomalies, oligohydramnios or polyhydramnios, any infant karyotypic, structural or metabolic abnormalities, method of delivery, cord complications, total cord length if short, and vessel number. If premature separation was noted clinically, it should be described. This is particularly appreciable at cesarean section, where the percentage of placental separation can be assessed. Common obstetrical abbreviations and methods of fetal evaluation are listed in Tables 1-4. A variety of antepartum evaluations may have been performed to determine fetal wellbeing. Fetal movement assessment by the mother, contraction stress testing, which evaluates the fetal heart rate with contractions, non-stress testing, which evaluates the appropriate fetal heart acceleration with movement, uterine artery Doppler velocimetry, or fetal pulse oximetry may be employed. The biophysical profile described by Manning and colleagues11 is a non-stress test combined with an ultrasound scoring system of antenatal fetal wellbeing, with a maximum score of 10 for five parameters. A normal score is ≥8/10, with 6/10 equivocal, and 4 or less an abnormal score1. Placentas may be evaluated prior to delivery by ultrasound, and a grading system may be applied (grade III being a mature placenta), although no good correlation has been shown with fetal lung maturity12. The normal aging process of the placenta includes calcifications, on which the grading system is based. Increased calcification has also been noted in mothers who smoke cigarettes, or who have thrombotic orders and are under prophylactic therapy with aspirin or heparin12. At birth, the infant is also evaluated. The Apgar score, described by Virginia Apgar13 (Table 3), is assessed at 1 min, 5 min, and sometimes again at 10 min. The 1-min score is a good indicator of the need for immediate medical intervention, while the 5-min score is prognostic of the longer-term welfare of the infant, with a score greater than or equal to 7 being a good indicator of survival. Placentas that are sent for pathological evaluation can be considered to fall into one of three categories: maternal issues, fetal issues, or placental issues (Table 5).
Does diurnal rhythm have an impact on fetal biophysical profile?
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2012
Enis Ozkaya, Eralp Baser, Mehmet Cinar, Vakkas Korkmaz, Tuncay Kucukozkan
Objectives. To investigate whether parameters in fetal biophysical profile (BPP) testing exhibit a diurnal rhythm and to discuss the probable factors associated with these variables. Methods. Thirty healthy primigravid patients carrying pregnancies between 35 and 40 completed weeks were enrolled for the study. Fetal BPP testing was performed for each patient both in the early morning (08:00–10:00 am) and in the late evening (08:00–10:00 pm), and the scoring parameters were compared between morning and evening tests. Results. BPP scores in the evening were significantly higher than that in the morning (p
Can vibroacoustic stimulation improve the efficiency of a tertiary care antenatal testing unit?
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2012
Amy L. Turitz, Jamie A. Bastek, Mary D. Sammel, Samuel Parry, Nadav Schwartz
Objective: Our primary objective was to determine whether vibroacoustic stimulation (VAS) decreases time to fetal reactivity in the antenatal testing unit (ATU) of a tertiary care center. Methods: We performed a prospective, quality assurance initiative to determine whether VAS could increase the efficiency of our ATU. On pre-specified “VAS days,” VAS was applied for 3 s, if the non-stress test was non-reactive in the first 10 min. Generalized estimating equations models were used to account for within subject correlation due to multiple appointments per patient. Results: VAS use was associated with a 3.76-min reduction in time to reactivity (21.79 vs 25.55, p = 0.011) and a 56% reduction in the need for a biophysical profile (OR: 0.44, 95% CI: 0.21–0.90). Overall, however, we found no significant decrease in time spent on the monitor or in the ATU. Conclusion: Compliance with a strict VAS protocol may improve the efficiency of increasingly busy ATUs.
Decreased placental thickness and impaired Doppler indices in idiopathic polyhydramnios: a prospective case–control study
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2015
Engin Akgündüz, Selçuk Erkılınç, Aytekin Tokmak, Ali İrfan Güzel, İrfan Özer, Nuri Danışman
Objective: To evaluate placental thickness, Doppler velocimetry, biophysical profile and perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios. Materials and methods: This prospective case–control study was conducted on 139 pregnant women, of these 70 patients with idiopathic polyhydramnios comprised the study group and 60 pregnant women comprised the control group. Risk factors recorded were; age, parity, body mass index (BMI), gestational weeks, amniotic fluid index (AFI), biophysical profiles (BPP), placental thickness, middle cerebral artery pulsatility index (MCA PI), umbilical artery Doppler velocimetry (Umb A S/D) values and perinatal outcomes. Results: Sixty-nine of the cases had mild-moderate (AFI: 250–450 mm) polyhydramnios (%98.5) and one of the cases had severe polyhydramnios (>450 mm) in study group. There was no statistically significant difference between the groups in terms of age, parity, BMI, gestational weeks, fetal birth weights and BPP (p > 0.05). Placental thickness, MCA PI and UA S/D values showed statistically significant difference between the groups (p
Related Knowledge Centers
- Amniotic Fluid Index
- Fetus
- NONstress Test