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Li X, Zhou M, Wang S, Zhang C. The role of multimodal ultrasound in diagnosis of fetal bowel dilatation and prediction of adverse neonatal outcomes: A study of 86 cases in a series of 43,562 births. Heliyon 2024; 10:e27455. [PMID: 38463772 PMCID: PMC10923836 DOI: 10.1016/j.heliyon.2024.e27455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Objective To investigate the diagnostic utility of multimodal ultrasound for fetal bowel dilatation (FBD) in different parts of the bowel and to examine its prognostic potential in FBD. Methods This retrospective study analyzed 86 fetuses with a dilated bowel identified via ultrasound in a 10-month postnatal follow-up. Both two- and three dimensional (2D and 3D, respectively) ultrasound volume imaging were used to characterize dilation across different bowel sections. The optimal intestinal diameter cut-off values for pathological bowel dilatation were determined and a predictive model for neonatal surgery was developed. Results The 86 cases of dilatation were distributed as follows: duodenal (n = 36); jejunum/ileum (n = 35); and colonic (n = 15). Duodenal dilatations presented the earliest during pregnancy compared to the other 2 groups (24.4 versus [vs.] 29 vs. 33.7 weeks respectively; p < 0.05). Cases with small intestinal dilatation were delivered earlier than those with colonic dilatation (p < 0.05). Infants with duodenal dilatation had the lowest birth weight and the highest rate of multi-system abnormalities (30.6% vs. 5.7% vs. 20%; p < 0.001). More than one-half of the multi-system abnormalities had chromosomal abnormalities (multiple, 54% vs. single, 12.5%; p = 0.015). There were 2 stillbirths, 24 induced labors, 44 postnatal surgeries, and 18 normal cases after birth. In predicting adverse neonatal outcomes of jejunum/ileum dilatation using a cut-off value of 15.5 mm small intestine diameter, sensitivity was 81.5%, specificity was 62.5%, and the area under the receiver operating characteristic curve (AUC) was 0.762 (p < 0.05). For colonic dilatation, using a cut-off value of 21.5 mm colon diameter: sensitivity was 83.3%, specificity was 77.8%, and AUC was 0.861 (p < 0.05). In detecting jejunum/ileum and colonic obstruction, 3D ultrasound demonstrated significantly better diagnostic efficiency than 2D ultrasound (p < 0.05). Using the backward stepwise selection method, a predictive model for neonatal surgery in patients with jejunum/ileum and colonic dilatation was established: logit (P) = -1.58 + (2.32 × polyhydramnios) +(2.0 × ascites) +(1.14 × hyperechogenic bowel). The AUC for the prediction model was 0.874 (p < 0.05), with 76% sensitivity and 94.1% specificity. Conclusions Duodenal dilatation occurred earlier, with a higher incidence of chromosomal abnormalities and multi-system abnormalities than dilatation of other parts of the bowel. 3D ultrasound played an important role in the detection of jejunum/ileum and colon obstructions. Clinical signs, including polyhydramnios, ascites, and strong echoes in the intestine, can be used to predict neonatal surgery.
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Affiliation(s)
- Xuelei Li
- Department of Ultrasound, Anhui Province Maternity and Child Health Hospital, Anhui, China
| | - Meng Zhou
- Department of Ultrasound, Anhui Province Maternity and Child Health Hospital, Anhui, China
| | - Shanshan Wang
- Department of Ultrasound, Anhui Province Maternity and Child Health Hospital, Anhui, China
| | - Chaoxue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Anhui, China
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Shen AW, Kothari A, Flint A, Kumar S. Prenatal imaging features and perinatal outcomes of foetal volvulus-A literature review. Prenat Diagn 2022; 42:192-200. [PMID: 34981841 DOI: 10.1002/pd.6083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/04/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To conduct a review of the literature on foetal volvulus with emphasis on prenatal imaging, pregnancy characteristics and clinical outcomes. METHODS A review of all published cases of foetal volvulus diagnosed prenatally and indexed in Medline, EBSCOhost, CINAHL, SOCIndex and Healthy Policy Reference Centre. Studies without antenatal sonographic signs of foetal volvulus and without a postpartum surgical diagnosis were excluded. Data were analysed for frequencies and distributions and tested for statistical significance. RESULTS Eighty-eight cases of foetal volvulus were identified from 58 published case reports/series. The most common ultrasound findings were dilated bowel/stomach (77.3%), polyhydramnios (30.7%) and whirlpool/snail sign (28.4%). Median gestation at diagnosis was 31.9 weeks (IQR 27-34) and mean gestation at delivery was 34.5 weeks (SD 2.8). Underlying aetiology included intestinal malrotation (15.9%), cystic fibrosis (14.8% of all cases, 32.5% of tested cases) and abnormal mesenteric fixation (12.5%). Complications included intestinal atresia (36.4%) and foetal anaemia (9.1%). The overall perinatal mortality rate was 14.5%. CONCLUSION Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. Intestinal malrotation and cystic fibrosis are common predisposing causes, although the majority are idiopathic. Bowel and/or gastric dilatation is by far the most common sonographic finding.
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Affiliation(s)
- Andrew Wang Shen
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Alka Kothari
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Anndrea Flint
- Department of Paediatrics, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Sailesh Kumar
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia.,Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.,Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
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Huang L, Huang D, Wang H, Zhang X, Yu H, Yang P. Antenatal predictors of intestinal pathologies in fetal bowel dilatation. J Paediatr Child Health 2020; 56:1097-1100. [PMID: 32073210 DOI: 10.1111/jpc.14825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
AIM Fetal bowel dilatation (FBD) in the late trimester of pregnancy can be related with varies of prognosis. Our aims were to obtain antenatal factors that might have relevance for the distinct prognosis with FBD. METHODS Seven features of 68 pregnancies presented with FBD were assessed. The best cut-off value to predict intestinal outcomes was selected using receiver-operating characteristics curves, and the effective variables were included into a logistic regression model. RESULTS The best cut-off valves to predict intestinal pathologies were 14.5 mm of fetus dilated loop and 37.7 weeks of gestational age at delivery, respectively. The congenital gastrointestinal tract anomalies included 24 cases (92.3%) of intestine atresia, 1 case (3.85%) of small intestine volvulus and 1 case (3.85%) of midgut malrotation. CONCLUSION Fetal dilated loops and gestational age at delivery are both an independent risk factor for predicting intestinal pathologies of newborns, which should arouse high attention.
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Affiliation(s)
- Lan Huang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danping Huang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongying Wang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiangxiang Zhang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongkui Yu
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Pan Yang
- Ultrasound Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Laird A, Shekleton P, Nataraja RM, Kimber C, Pacilli M. Incidence of gastro-intestinal anomalies and surgical outcome of fetuses diagnosed with echogenic bowel and bowel dilatation. Prenat Diagn 2019; 39:1115-1119. [PMID: 31461799 DOI: 10.1002/pd.5552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to evaluate the incidence of gastro-intestinal (GI) anomalies and surgical outcome in fetuses diagnosed with either echogenic bowel (EB) or EB plus bowel dilatation (BD) but no associated chromosomal, DNA and/or additional structural defects. METHODS A 10-year (2008-2018) retrospective review was performed on all fetuses diagnosed with EB and EB+BD (RES-18-0000-072Q). Results are reported as number of cases (%) and mean ±SD. Fisher's exact test, Mann-Whitney U test and logistic regression were used to identify differences between groups and predisposing factors for gastro-intestinal anomalies. RESULTS We identified 41 fetuses with EB and 14 fetuses with EB+BD. Post-natal surgical intervention was required in no patient of the EB group and in 7/14 (50%) of the EB+BD group, p<0.001. The risk of having a GI anomaly was higher in the EB+BD group (RR 42.0 [2.5-691.6]; p=0.009). Advanced maternal age (p=0.04), ascites (p=0.006) and polyhydramnios (p=0.007) were associated with a higher incidence of GI pathology. CONCLUSIONS In fetuses with no associated chromosomal, DNA and/or additional structural defects, the finding of EB+BD is associated with 50% incidence of GI anomalies at birth. Advanced maternal age, ascites and polyhydramnios are also associated with higher incidence of GI pathology at birth.
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Affiliation(s)
- Ashleigh Laird
- School of Clinical Sciences at Monash Health, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Paul Shekleton
- Fetal Diagnostic Unit, Monash Health, Melbourne, Victoria, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics.,Department of Surgery,School of Clinical Sciences at Monash Health, Medicine, Nursing and Health Sciences, Monash University,, Melbourne, Victoria, Australia
| | - Christopher Kimber
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics.,Department of Surgery,School of Clinical Sciences at Monash Health, Medicine, Nursing and Health Sciences, Monash University,, Melbourne, Victoria, Australia
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Goruppi I, Arévalo S, Gander R, Molino JA, Oria M, Carreras E, Peiro JL. Role of intraluminal bowel echogenicity on prenatal ultrasounds to determine the anatomical level of intestinal atresia. J Matern Fetal Neonatal Med 2016; 30:103-108. [PMID: 27023781 DOI: 10.3109/14767058.2016.1163677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the correlation between different degrees of bowel intraluminal echogenicity showed by prenatal ultrasounds and the anatomic level of intestinal atresia. METHODS We report three cases of intestinal atresia at different intestinal levels verified during the neonatal surgery with specific ultrasonographic prenatal features. Intensity of sonolucency was analyzed using the image-processing program ImageJ for quantitative measurements based on the gray-scale intensity values. RESULTS A total of three cases are reported, a jejunal, an ileal and a colonic atresia. All cases showed intestinal dilatation. Both, jejunal and ileal atresia, showed two degrees of hypoechoic intestinal content, while colonic atresia showed hyperechogenic content dilated loop at prenatal ultrasound scan. CONCLUSIONS We propose the use of prenatal ultrasounds echogenicity of intestinal dilated loop fluid content to help in determining the level of obstruction in bowel atresia. These are initial results, to be confirmed by a multicentric research with more cases.
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Affiliation(s)
| | - Silvia Arévalo
- b Fetal Medicine Unit, Hospital Universitari Vall d'Hebron , Barcelona , Spain , and
| | | | | | - Marc Oria
- c Pediatric General and Thoracic Surgery Division, Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center (CCHMC) , Cincinnati , OH , USA
| | - Elena Carreras
- b Fetal Medicine Unit, Hospital Universitari Vall d'Hebron , Barcelona , Spain , and
| | - José-Luis Peiro
- a Pediatric Surgery Department , and.,c Pediatric General and Thoracic Surgery Division, Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center (CCHMC) , Cincinnati , OH , USA
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Virgone C, D'antonio F, Khalil A, Jonh R, Manzoli L, Giuliani S. Accuracy of prenatal ultrasound in detecting jejunal and ileal atresia: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:523-529. [PMID: 25157626 DOI: 10.1002/uog.14651] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/02/2014] [Accepted: 08/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The accuracy of prenatal ultrasound examination in detecting jejunal and ileal atresia has been reported in the literature to be highly variable, at 25-90%. The aim of this systematic review was to evaluate the accuracy of prenatal ultrasound in detecting non-duodenal small bowel atresia (ND-SBA). METHODS MEDLINE, EMBASE and The Cochrane Library, including The Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE) and The Cochrane Central Register of Controlled Trials (CENTRAL), were searched electronically. The overall detection rate of jejunal or ileal atresia using ultrasound was reported. The accuracy of using polyhydramnios and dilated loops of bowel as diagnostic signs was also explored. RESULTS Sixteen studies involving 640 fetuses were included in this review. The detection rate of ND-SBA by prenatal ultrasound was highly variable, with values ranging from 10 to 100%, with an overall prediction of 50.6% (95% CI, 38.0-63.2%). When analyzed separately, the detection rates of jejunal and ileal atresia were 66.3%, (95% CI, 33.9-91.8%) and 25.9% (95% CI, 4.0-58.0%), respectively. Both dilated loops of bowel and polyhydramnios as diagnostic signs for ND-SBA provided a low overall detection rate. CONCLUSIONS The diagnostic performance of prenatal ultrasound in identifying ND-SBA is extremely variable. Large studies are needed in order to identify objective and combined criteria for the diagnosis of these anomalies.
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Affiliation(s)
- C Virgone
- Department of Paediatric and Neonatal Surgery, St. George's Healthcare NHS Trust and University of London, London, UK
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John R, D'Antonio F, Khalil A, Bradley S, Giuliani S. Diagnostic Accuracy of Prenatal Ultrasound in Identifying Jejunal and Ileal Atresia. Fetal Diagn Ther 2015; 38:142-6. [DOI: 10.1159/000368603] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 09/21/2014] [Indexed: 11/19/2022]
Abstract
Introduction: Small bowel atresia (SBA) is one of the most common causes of congenital intestinal obstruction. However, the accuracy of prenatal ultrasound in diagnosing this condition has not been entirely ascertained. The aim of this study was to analyse the predictive accuracy of ultrasound in detecting SBA prenatally. Methodology: Retrospective study of all cases with prenatal suspicion or postnatal confirmed SBA seen in a tertiary fetal medicine and pediatric surgery units from 2007 to 2013. Cases with duodenal atresia were excluded from the study. The predictive accuracy of ultrasound and different ultrasound signs, alone and in combination, was calculated. Results: 65 fetuses with prenatal suspicion or postnatal confirmed SBA were enrolled. 58 cases had full data and were included in the analysis. Predictive accuracy of ultrasound in detecting the presence of SBA was poor, with a sensitivity of 50% (95% CI 26.0-74.0) and a specificity of 70.59% (95% CI 52.5-84.9). The presence of both bowel dilatation ≥17 mm and polyhydramnios after 32 weeks of gestation slightly increased sensitivity (66.67%, 95% CI 34.9-90.1) and specificity (80.00%, 95% CI 44.4-97.5). Conclusions: In case of suspicion of SBA before the 3rd trimester, an ultrasound after 32 weeks should be performed to confirm the presence of both polyhydramnios and bowel dilatation >17 mm.
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