The role of ultrasound and antenatal single-shot fast spin-echo MRI in the evaluation of herniated bowel in case of first trimester ultrasound diagnosis of fetal gastroschisis

Gabriele Tonni, Pierpaolo Pattaccini, Alessandro Ventura, Giovanni Casadio, Carmine Del Rossi, Bruno Ferrari
Archives of Gynecology and Obstetrics 2011, 283 (4): 903-8

OBJECTIVE: To report on a clinical antenatal management strategy based on integrating ultrasound (US) and magnetic resonance imaging (MRI) in the evaluation of herniated bowel following early prenatal diagnosis of gastroschisis.

METHODS: Antenatal US and ultrafast single-shot spin-echo (SSSE) MRI.

RESULTS: Fetal gastroschisis was documented at 12 weeks at the time of first trimester screening for Down syndrome. Fetal karyotype was performed at 16 weeks and showed a 46,XY karyotype. Ultrasound scan at 20 weeks diagnosed gastroschisis as isolated finding. Follow-up scans were planned monthly, and antenatal ultrafast SSSE MRI was arranged at 35 weeks and demonstrated a right fetal abdominal wall defect measuring 2.4 mm on transverse diameter with an integrity of the intra-abdominal and extra-abdominal loops of small bowel. The colon was in situ as were the stomach, the liver, and the spleen.

CONCLUSIONS: The choice of integrating both the diagnostic procedures has shown to be clinically useful in planning the timing of delivery (Cesarean section) and in turn has been associated with an easy surgical repair and to a favorable postnatal outcome. The result of amniocentesis was crucial for the parent's decision-making process whether to continuing with the pregnancy. Moreover, amniotic fluid α-fetoprotein levels may be used as an index of small bowel damage when loops of small bowel lied uncovered within the amniotic cavity.

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