Intrauterine death rate in gastroschisis following the introduction of an antenatal surveillance programme: a retrospective observational study

Abstract

Aim: to investigate whether an antenatal surveillance protocol including ultrasound and Cardiotocograph monitoring reduces intra-uterine death (IUD) in cases of gastroschisis.Secondary outcomes included neonatal death rate, mode of delivery and rate of intervention before planned time of delivery.

Methods:this was a retrospective observational study of all women with an antenatally diagnosed gastroschisis who were managed according to our surveillance programme between 2002 and 2015 in a tertiary fetal medicine and paediatric surgical centre covering the Wessex Region of England. We reviewed and analysed data from the WANDA database as well as prospectively managed maternity, ultrasound and neonatal databases over the given time period. Case notes were reviewed when delivery was expedited.

Results: the intra-uterine death rate was 2.2%, a 58% reduction since the introduction of our surveillance protocol. Delivery was expedited in 35.4% of cases and in 86% of these, delivery was by caesarean section. In women being induced as planned at 38 weeks, the vaginal delivery rate was 88% and for those in spontaneous labour before 38 weeks it was 75%.

Conclusions: an antenatal surveillance programme appears to reduce the intra-uterine death in gastroschisis. In a third of cases, delivery was indicated before the planned date of delivery. When expedited delivery was indicated, the chance of caesarean section was high.

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ORCID for Nigel Hall: orcid.org/0000-0001-8570-9374

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