Prognosis in isolated gastroschisis with bowel dilatation: a systematic review

Clare L Tower ^1*, Stephen SC Ong ², Andy K Ewer ³, Khalid Khan ⁴ and Mark D Kilby ⁴

¹ University of Manchester, United Kingdom
² Belfast Royal Jubilee Hospital, United Kingdom
³ Birmingham Women's Hospital, United Kingdom
⁴ University of Birmingham, United Kingdom

^* To whom correspondence should be addressed. E-mail: clare.tower{at}manchester.ac.uk.

Accepted 14 October 2008

Abstract

Objectives: To investigate prognosis of the fetus with isolated gastroschisis and bowel dilatation from a systematic review of the literature. We aimed to compare the incidence of a) intrauterine death b) death within 4 weeks of delivery c) bowel resection, d) length of time to oral feeds, e) time as inpatient in fetuses with gastroschisis with and without evidence of bowel dilatation.

Methods: Literature was identified by searching two bibliographical databases between 1980 and 2007. Studies were assessed for quality and stratified according to the definition of bowel dilatation. The data extracted was inspected for clinical and methodological heterogeneity.

Results: The search strategy yielded 1335 potentially relevant citations. Full manuscripts were retrieved for 92 citations. 10 studies (273 patients) were finally included in the systematic review. No difference was found between groups for death within 4 weeks of delivery (OR = 0.62; (95% CI 0.11 to 3.32); heterogeneity p = 0.39) or bowel resection (OR = 3.35 (95% CI 0.82 to 13.74); heterogeneity p = 0.39). There was insufficient data to compare the risk of intrauterine death and length of time to oral feeds. The mean inpatient stay was not significantly different (OR =16.63; (95% CI 0.98 to 32.28); heterogeneity p = 0.23).

Conclusion: Current available evidence suggests that fetuses with isolated gastroschisis and bowel dilatation are not at increased risk of adverse perinatal outcome, compared to those without bowel dilatation. However, there is a paucity of studies, and a randomised controlled trial is urgently needed.