Surveillance of gastroschisis

Summary

The birth prevalence of gastroschisis has increased worldwide; however, incomplete geographical coverage by regional congenital anomaly registers makes this difficult to study on a national basis in the UK. The aims of this study were to document the prevalence of gastroschisis nationally and to describe management and outcomes. Parallel national descriptive studies were conducted using the UK Obstetric Surveillance System (UKOSS) and the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS), commencing in October 2006. Cases were compared with cases reported to the British Isles Network of Congenital Anomalies Registers (BINOCAR).

Key findings

• The overall estimated birth prevalence of gastroschisis was 4.2 cases per 10 000 total births (95%CI 3.6-4.8).
• Estimates based on these data suggest that four per 100 fetuses surviving to the third trimester are stillborn (95%CI 2–6), four per 100 affected infants born alive die in the neonatal period (95%CI 1–10) and fewer than 1% of surviving infants die in the postnatal period (0.7 per 100 infants, 95%CI 0 – 2).
• Infants were variably monitored with growth scans (90%), umbilical artery Doppler ultrasound (85%), cardiotocography (65%) and biophysical profile (27%). Bowel measurements were undertaken for only 113 infants (52%).
• Eighty-nine women (43%) were induced and 63 (31%) laboured spontaneously.
• There were no statistically significant differences in growth measurements or gestation at delivery between babies who were stillborn or liveborn or those who died and those who survived, but note that this analysis has limited power to detect any differences as statistically significant due to a low number of deaths.
• The variability in management and paucity of evidence on antenatal monitoring approaches suggests there may be a place for randomised trials of fetal surveillance strategies in order to develop the evidence to improve outcomes for the at-risk fetus with gastroschisis.

Publications

Journal Articles

• Overton TG, Pierce MR, Gao H, Kurinczuk JJ, Spark P, Draper ES, Marven S, Brocklehurst P, Knight M. Antenatal management and outcomes of gastroschisis in the U.K. Prenat Diagn. 2012;32(13):1256-62.
• Allin BSR, Tse WHW, Marven S, Johnson PRV, Knight M. Challenges of Improving the Evidence Base in Smaller Surgical Specialties, as Highlighted by a Systematic Review of Gastroschisis Management. PLoS One. 2015;10(1):e0116908.