Serial transabdominal amnioinfusion in the management of gastroschisis with severe oligohydramnios.
ABSTRACT Two fetuses with gastroschisis diagnosed in utero (at 19 weeks' gestation) had severe oligohydramnios at 30 to 31 weeks. Serial transabdominal amnioinfusions were performed to fill the amniotic cavity with saline, thereby avoiding the potential consequences of fetal exposure to severe oligohydramnios. In both cases, premature rupture of membranes occurred at 36 weeks, and the fetuses were delivered by cesarean section. There were minimal lesions of the extraabdominal bowel. After primary closure of the abdomen, the postoperative course was uneventful. These observations show that serial amnioinfusion is a feasible therapeutic approach for severe third-trimester oligohydramnios associated with gastroschisis.
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ABSTRACT: Mortality of patients with gastroschisis has decreased from nearly 90% to 13% (14 of 106) during the period from 1967 to 1984. Coincident with advances in perioperative management, including parenteral nutrition and mechanical ventilation, has been the introduction of staged reduction of the viscera using prosthetic material. To assess the relative merits of primary closure, skin flap coverage, and silo reduction, operative treatment of 106 consecutive infants with gastroschisis was reviewed. Primary fascial closure was accomplished in 54 patients (52%). When fascial approximation resulted in excessive intra-abdominal pressure, the viscera were covered with lateral skin flaps in 10 infants (10%), or the defect was closed after staged reduction with a prosthetic silo in 40 infants (38%). Detailed analysis of the hospital records revealed no significant differences between the primary closure, skin flap, and silo groups with regard to duration of ileus (22 +/- 25, 30 +/- 27, 31 +/- 30 days), length of hospitalization (39 +/- 36, 54 +/- 37, 53 +/- 39 days), or mortality (6, 20, 18%). Respiratory, septic, hemorrhagic, renal, and wound complications occurred in significantly fewer patients with primary closure (36%) and skin flap coverage (30%) than in those with silos (68%) (p less than 0.05). Postoperative mortality was 12% (12/104) and was most often due to respiratory insufficiency (35%) or nonviable small bowel (19%). Primary fascial closure may be accomplished safely in a majority of patients with gastroschisis. However, no single operative strategy is ideal for all patients with gastroschisis, and initial treatment of individual defects should be tailored to the degree of visceroabdominal disproportion.Annals of Surgery 03/1986; 203(2):214-8. · 6.33 Impact Factor
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ABSTRACT: A retrospective study compared two comparable consecutive groups of nonlaboring primiparas beyond 41 weeks with severe oligohydromanios (no amniotic pocket more than 2 cm deep). Transabdominal amnioinfusions were not done in the historical control group (n = 14) but were done in the second group (n = 11). Fetal heart rate patterns and neonatal outcome were better in the group with amnioinfusion than in controls, and the rate of cesarean delivery was significantly lower (18 vs. 93%, p < 0.001). These results suggest that prepartum transabdominal amnioinfusion may have obstetrical and perinatal benefits for nonlaboring postdates with oligohydramnios, especially when the cervix is unripe.Fetal Diagnosis and Therapy 01/1993; 8(6):412-7. · 1.90 Impact Factor
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ABSTRACT: Previous work in the fetal lamb examined the relative effects of amniotic fluid and bowel constriction in the etiology of bowel damage in gastroschisis. The present study used the same model to assess the timing and reversibility of these changes during gestation. Gastroschisis was created at 80 days' gestation, and a tape was placed around the bowel to cause gradual constriction with growth. Lambs were killed at 100 days, 120 days, and term. Bowel damage was assessed using histology, mucosal enzyme activity, and in vitro motility. In an additional "repaired" group, the constrictor was removed at 120 days, a silastic pouch placed over the bowel, and bowel damage assessed at term. Normal fetuses at each gestational age were used as controls. A fibrous peel was observed at all gestational ages. Mucosal villous atrophy and mesenteric venous and lymphatic dilation were mild at 100 and 120 days, but severe at term. These changes were present but mild in repaired animals at term. Mucosal enzyme activity decreased gradually with gestational age; inhibition of maltase activity was maximal at term, and was significantly reversed by repair, whereas inhibition of aminooligopeptidase activity was maximal at 120 days, and was not affected by repair. Protein/DNA, DNA/weight, and protein/weight ratios showed that repaired mucosal cells were significantly more proliferative, smaller, and less mature than control or gastroschisis cells. In vitro motility studies demonstrated a mild decrease in contractility at 100 and 120 days, and a large decrease at term. This deleterious effect at the end of gestation was only partially reversed by repair in utero.(ABSTRACT TRUNCATED AT 250 WORDS)Journal of Pediatric Surgery 12/1990; 25(11):1122-6. · 1.38 Impact Factor