Defectos De Pared Abdominal
Revista Chilena de Ultrasonografía. Volumen 9 / Nº 3 / 2006
Defectos de Pared Anterior del Abdomen: Diagnóstico prenatal y seguimiento*
Drs. Patricia Muñoz O(1), Juan G. Rodríguez A(1), Virginia Valdés O(2), Jorge Godoy L(2), Francisco Ossandón C(2), Oscar Pizarro R(1), Jean Pierre Frez B(1).
1. Centro de Referencia Perinatal Oriente, CERPO.Servicios de Obstetricia y Ginecología y Neonatología, Hospital Santiago Oriente "Dr. Luis Tisné Brousse". 2. Servicios de Neonatología y Cirugía infantil, Hospital Luis Calvo Mackenna.
72
Abstract Abdominal wall defects are ranking in the 4th place of congenital malformations. The most frequent ones are gastroschisis and omphalocele, which show a high perinatal mortality. Over the last 30years, world incidence has grown. The national incidence and prevalence of these defects should be determined. Objective: The analysis of trends in clinical characteristics of these defects referred to a national centre and treated in Santiago, Chile, between March 2003 and August 2006. Method: 7 cases of omphalocele and 7 cases of gastroschisis were analysed. We studied associated risk factors,prenatal management and postnatal follow-up. Results: The average maternal age in gastroschisis was 18 and 28.4 in omphalocele. Five patients with gastroschisis were primigravida. None of the patients had a history of drugs, alcohol or tobacco intake. Six of seven omphalocele cases we associated with other malformations, three of them were multiple malformations Cantrell type. None of the cases ofgastroschisis showed any associated malformations. In six cases of omphalocele and in one case of gastroschisis fetal karyotyping was studied. Six cordocentesis and one amniocentesis were performed. Results were one Trisomy 18 (omphalocele) and six normal kariotype. In three cases of omphalocele, the babies were delivered with elective cesarean section. In three cases of omphalocele and all casesof gastroschisis, urgent Cesarean section had to be performed. There was one vaginal delivery with a stillborn (Trisomy 18). Among the gastroschisis cases and three of the omphalocele cases, four children were born prematurely. The average weight of the newborns with gastroschisis was 2.365 gr., and 2.770 gr., in omphalocele cases. The distribution by sex in gastroschisis was 6 females: 1 male, incases of omphalocele it was 4 females: 3 males. Of all 14 cases, two died during the first hours, and one was a stillborn. In the first three months of
life, three children with omphalocele and one with gastroschisis passed away. The average days with assisted mechanical ventilation were 40.7 in omphalocele and 9.8 days in cases of gastroschisis. A primary closure of the defect was possible inthree cases of gastroschisis; however there was none in omphalocele. Staged reduction was observed in four cases of gastroschisis and in four cases of omphalocele. The most frequent complications in gastroschisis were perforations, peritonitis and sepsis; in omphalocele, respiratory distress and respiratory insufficiency. Conclusions: In this study the number of cases of omphalocele andgastroschisis were similar when compared to the expected relation: 3:2, which suggests an increase in the incidence of gastroschisis. Women under 20 who are pregnant for the first time and belong to a low social economic level are more bound to develop gastroschisis. Omphalocele shows in older women; it is associated frequently to other malformations and chromosomal anomalies and has a higher mortalityrate. For children with gastroschisis, the prognosis is better and depends on the grade of premature birth and on eventual intestinal complications. One can conclude that ultrasound does permit an adequate screening of our reality. An opportune derivation to a third level centre is necessary. The obstetrical management still remains controversial. There is no statistical variation between Cesarean...
Regístrate para leer el documento completo.