Patricio E Lau1, Stephanie Cruz1, Christopher I Cassady2, Amy R Mehollin-Ray2, Rodrigo Ruano3, Sundeep Keswani4, Timothy C Lee1, Oluyinka O Olutoye5, Darrell L Cass6. 1. Texas Children's Fetal Center, Houston, TX; Baylor College of Medicine Department of Surgery, Houston, TX. 2. Baylor College of Medicine Department of Radiology, Houston, TX. 3. Texas Children's Fetal Center, Houston, TX; Baylor College of Medicine Department of Obstetrics and Gynecology, Houston, TX. 4. Texas Children's Fetal Center, Houston, TX; Baylor College of Medicine Department of Surgery, Houston, TX; Baylor College of Medicine Department of Obstetrics and Gynecology, Houston, TX. 5. Texas Children's Fetal Center, Houston, TX; Baylor College of Medicine Department of Surgery, Houston, TX; Baylor College of Medicine Department of Radiology, Houston, TX; Baylor College of Medicine Department of Obstetrics and Gynecology, Houston, TX. 6. Texas Children's Fetal Center, Houston, TX; Baylor College of Medicine Department of Surgery, Houston, TX; Baylor College of Medicine Department of Radiology, Houston, TX; Baylor College of Medicine Department of Obstetrics and Gynecology, Houston, TX. Electronic address: DLCass@texaschildrens.org.
Abstract
INTRODUCTION: The purpose of this study was to evaluate the accuracy of prenatal diagnosis for fetuses with gastrointestinal (GI) obstruction with correlation to postnatal outcomes. METHODS: Fetuses diagnosed with GI obstruction (excluding esophageal and duodenal) were reviewed for those evaluated between 2006 and 2016. Prenatal diagnosis and imaging studies were compared to postnatal findings. Outcomes evaluated included diagnostic accuracy, rate of other anomalies, neonatal length of stay, incidence of short bowel syndrome, and discharge with TPN or gastrostomy. RESULTS: Forty-eight patients were diagnosed prenatally with obstruction. Six patients were excluded owing to incomplete records and follow-up. Twelve fetuses were diagnosed with ultrasound alone, and thirty-four with ultrasound and MRI. A diagnosis of obstruction was accurate in 88.1% (n=37/42) with a positive predictive value of 91.3%, while US with MRI had an accuracy of 84.4%. Associated anomalies were highest among fetuses with anorectal obstruction (90.1%), compared to large (50%) or small bowel obstruction (28%). Survival rate was lowest for anorectal obstruction (54.5%), compared to large or small bowel obstruction (100% for both). CONCLUSION: Fetal MRI is an accurate modality in the diagnosis of fetal GI obstruction and can complement findings characterized by ultrasound. Fetuses with anorectal obstruction have a higher rate of associated anomalies and the lowest survival. LEVEL OF EVIDENCE: IIb.
INTRODUCTION: The purpose of this study was to evaluate the accuracy of prenatal diagnosis for fetuses with gastrointestinal (GI) obstruction with correlation to postnatal outcomes. METHODS: Fetuses diagnosed with GI obstruction (excluding esophageal and duodenal) were reviewed for those evaluated between 2006 and 2016. Prenatal diagnosis and imaging studies were compared to postnatal findings. Outcomes evaluated included diagnostic accuracy, rate of other anomalies, neonatal length of stay, incidence of short bowel syndrome, and discharge with TPN or gastrostomy. RESULTS: Forty-eight patients were diagnosed prenatally with obstruction. Six patients were excluded owing to incomplete records and follow-up. Twelve fetuses were diagnosed with ultrasound alone, and thirty-four with ultrasound and MRI. A diagnosis of obstruction was accurate in 88.1% (n=37/42) with a positive predictive value of 91.3%, while US with MRI had an accuracy of 84.4%. Associated anomalies were highest among fetuses with anorectal obstruction (90.1%), compared to large (50%) or small bowel obstruction (28%). Survival rate was lowest for anorectal obstruction (54.5%), compared to large or small bowel obstruction (100% for both). CONCLUSION: Fetal MRI is an accurate modality in the diagnosis of fetal GI obstruction and can complement findings characterized by ultrasound. Fetuses with anorectal obstruction have a higher rate of associated anomalies and the lowest survival. LEVEL OF EVIDENCE: IIb.
Authors: Bridgette M McCormick; Karin J Blakemore; Clark T Johnson; Juliet C Bishop; Eric B Jelin; Jeanne M Miklos; Angie C Jelin Journal: Am J Obstet Gynecol MFM Date: 2020-10-29