The Efficacy of Antepartum Testing in Pregnancies Complicated by Fetal Gastroschisis [32M]

INTRODUCTION: Our objective was to determine if our approach to antepartum testing is effective at reducing perinatal mortality in fetuses with gastroschisis. METHODS: This retrospective case series analyzed fetuses with gastroschisis that underwent intensive fetal surveillance from 2008 to 2016. Data collected included maternal demographics, antenatal fetal testing, influence of testing on timing of delivery, gestational age at delivery, indication for delivery, and perinatal complications. The antenatal fetal surveillance was guided by the following testing protocol: monthly growth scan, twice weekly fetal testing with BPP/NST, consultation with a perinatologist, and strict maternal kick counting. RESULTS: This study had 11 patients, majority of which were young primiparous Hispanic women. IUGR complicated 59.5% of our pregnancies with gastroschisis. Bowel dilation greater than 18mm was noted in 31.8% of fetuses with gastroschisis; one was delivered due to bowel dilatation greater than 25 mm. Fourteen patients were sent to L&D from ATU, of which 9 were for nonreassuring fetal testing and 2 related to ultrasound findings. All patients sent from ATU for fetal compromise diagnosed on testing were delivered within 48 hours. Eleven patients were delivered for compromised fetal status as determined by abnormal fetal testing and/or decreased fetal movement. Prevalence of IUFD in fetal gastroschisis in our case series was 0%, as compared to 4.48% reported in the literature. CONCLUSION: Our protocol for antenatal fetal surveillance was effective in identifying the compromised fetus with gastroschisis leading to timely delivery. Increased awareness of IUFD and our comprehensive fetal testing protocol resulted in survival of all fetuses in this study.