Parâmetros maternos fetais e evolução pós-natal de fetos com gastrosquise

Abstract

Gastroschisis is a parabilical defect of the closure of the anterior wall of the abdomen, through which the viscera of the abdominal cavity can be herniated to varying degrees. Most of the time, it appears as an isolated malformation, without association with other structural or chromosomal anomalies, unlike other fetal malformations. It is the most common defect of the abdominal wall, with an incidence of 2 to 5 per 10,000 live births. The prognosis of gastroschisis remains adverse in developing countries and factors associated with death are controversial in the literature. The Fetal Medicine Center of the Hospital das Clínicas of UFMG (CEMEFE-UFMG) is a care and research center specializing in Fetal Medicine and a reference in prenatal care and with great experience in the postnatal surgery of these individuals, The present study aims to prospectively evaluate the maternal, fetal and evolutionary factors of the disease, associating them with perinatal outcomes in patients with gastroschisis seen at CEMEFE-UFMG. Maternal, epidemiological, fetal and obstetric factors of 31 pregnancies were observed through a prospective analysis, and their influence on the occurrence of neonatal death and other unfavorable outcomes such as time and type of surgical approach, surgical complications, time intensive care unit admission, mechanical ventilation time, parenteral nutrition and enteral diet time. The knowledge of the prognostic factors allows to establish an adequate prenatal follow-up protocol, as well as the planning of place and delivery in a referral center with a neonatal unit qualified for the surgical treatment of these infants. All of these are clearly cost-effective measures, requiring the least investment with maximum return in terms of reducing neonatal morbidity and mortality. The present study demonstrated a correlation of secondary closure and Apgar scores below 8 with postnatal death. It was also demonstrated the significant correlation between primary surgical correction and gestational age less than 37 weeks.No correlation of prenatal factor with postnatal death was shown. We conclude that studies with a larger number of patients are necessary to better evaluate postnatal outcomes based on ultrasound markers and prenatal follow-up to better advise families and improve postnatal prognosis.