Ukrainian Journal of Perinatology and Pediatrics. 2024. 3(99): 104-108. doi: 10.15574/PP.2024.3(99).104108
Sliepov O. K., Skripchenko N. Y., Ponomarenko O. P., Znak K. L.
SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine», Kyiv

For citation: Sliepov OK, Skripchenko NY, Ponomarenko OP, Znak KL. (2024). Prevention of pathological changes of eventerated organs in gastroschisis in fetuses and newborns. Ukrainian Journal of Perinatology and Pediatrics. 3(99): 104-108. doi: 10.15574/PP.2024.3(99).104108.
Article received: May 12, 2024. Accepted for publication: Sep 04, 2024.

The primary cause of unsatisfactory outcomes in the treatment of gastroschisis (GS) is the pathological changes in eviscerated organs and their consequences. One preventive method against these pathological changes is the premature delivery of pregnant women with fetal GS, either by physiological means or cesarean section.
Aim – to analyze and develop preventive measures for pathological changes in eviscerated organs in GS by optimizing the delivery timing and method in pregnant women, to improve outcomes in fetuses and neonates.
Materials and methods. The study examined the impact of delivery timing and method on the condition of eviscerated organs in 118 neonates with isolated (uncomplicated) GS. Depending on the delivery method, patients were divided into two groups: Group I included 72 neonates born at the SI “Institute of Pediatrics, Obstetrics, and Gynecology named after Acad. O.M. Lukyanova of the NAMS of Ukraine” between 2006 and 2023 via cesarean section, with 80% of cases being premature (at 35-37 weeks gestation); Group II included 46 neonates delivered vaginally between 1987 and 2005, who were treated either at the Institute (n=23) or at the Mykolaiv Regional Children’s Clinical Hospital (n=23). Neonates with complicated GS forms were excluded from the study. According to the degree of pathological changes in the eviscerated organs, cases were classified as unchanged, moderately changed, or markedly changed.
Results. The implementation of planned premature cesarean delivery for pregnant women with fetal GS effectively reduced the occurrence of marked changes of eviscerated organs by 49.1%. At the same time, there was a significant increase (49.2%) in cases with unchanged and moderately changed organ conditions.
Conclusions. One of the preventive measures to reduce the frequency and degree of pathological changes in eviscerated organs in GS is planned premature cesarean delivery at 37 weeks gestation. This approach positively influences the condition of eviscerated organs in fetuses with GS, preventing marked pathological changes in two-thirds of cases and significantly increasing (by 49.2%) the occurrence of unchanged or moderately changed organs.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution's Local Ethics Committee, and informed consent was obtained from the patients.
Authors declare no conflict of interest.
Keywords: gastroschisis, fetus, intestinal lesions, prevention, cesarean section, premature delivery.

REFERENCES

1. Amin R, Domack A, Bartoletti J, Peterson E, Rink B, Bruggink J et al. (2019). National Practice Patterns for Prenatal Monitoring in Gastroschisis: Gastroschisis Outcomes of Delivery (GOOD) Provider Survey. Fetal Diagn Ther. 45(2): 125-130. Epub 2018 May 23. https://doi.org/10.1159/000487541; PMid:29791899

2. Baerg J et al. (2003). Gastroschisis: A sixteen-year review. J Pediatr Surg. 38(5): 771-774. https://doi.org/10.1016/jpsu.2003.50164; PMid:12720191

3. Bittencourt D et al. (2006). Impact of corticosteroid of intestinal injury in a gastroschisis rat model: a morphometric analysis. J Pediatr Surg. 41(3): 547-553. https://doi.org/10.1016/j.jpedsurg.2005.11.050; PMid:16516633

4. Bond DM, Middleton P, Levett KM, van der Ham DP, Crowther CA et al. (2017, Mar 3). Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 3(3): CD004735. PMCID: PMC6464692. https://doi.org/10.1002/14651858.CD004735.pub4; PMid:28257562

5. Chen Y, Zhao J, Alganabi M, Mesas-Burgos C, Eaton S, Wester T, Pierro A. (2023, Feb). Elective Delivery versus Expectant Management for Gastroschisis: A Systematic Review and Meta-Analysis. Eur J Pediatr Surg. 33(1): 2-10. Epub 2022 Jul 11. https://doi.org/10.1055/a-1896-5345; PMid:35817335

6. Feng C et al. (2016). Transamniotic stem cell therapy (TRASCET) mitigates bowel damage in a model of gastroschisis. J Pediatr Surg. 51(1): 56-61. https://doi.org/10.1016/j.jpedsurg.2015.10.011; PMid:26548631

7. Girsen AI, Davis AS, Hintz SR, Fluharty E, Sherwin K, Trepman P et al. (2020). Effects of Gestational Age at Delivery and Type of Labor on Neonatal Outcomes Among Infants with Gastroschisis. J. Matern. Neonatal Med. 34: 2041-2046. https://doi.org/10.1080/14767058.2019.1656191; PMid:31409162

8. Girsen AI, Wallenstein MB, Davis AS, Hintz SR, Desai AK, Mansour T et al. (2016). Effect of antepartum meconium staining on perinatal and neonatal outcomes among pregnancies with gastroschisis. J. Matern. Fetal Neonatal Med. 29: 2500-2504. https://doi.org/10.3109/14767058.2015.1090971; PMid:26445130

9. Goldstein MJ, Bailer JM, Gonzalez-Brown VM. (2022, Jul). Preterm vs term delivery in antenatally diagnosed gastroschisis: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 4(4): 100651. Epub 2022 Apr 22. https://doi.org/10.1016/j.ajogmf.2022.100651; PMid:35462060

10. Grant NH, Dorling J, Thornton JG. (2013). Elective preterm birth for fetal gastroschisis. Cochrane Database Syst. Rev. (6):CD009394. PMID: 23737031. https://doi.org/10.1002/14651858.CD009394.pub2

11. Hakguder G et al. (2011). Induction of fetal diuresis with intraamniotic furosemide injection reduces intestinal damage in a rat model of gastroschisis. Eur J Pediatr Surg. 21(3): 183-187. https://doi.org/10.1055/s-0031-1271708; PMid:21341178

12. Harper LM, Goetzinger KR, Biggio JR, Macones GA. (2015). Timing of elective delivery in gastroschisis: A decision and cost-effectiveness analysis. Ultrasound Obstet. Gynecol. 46: 227-232. https://doi.org/10.1002/uog.14721; PMid:25377308 PMCid:PMC4861040

13. Jaczyńska R, Mydlak D, Mikulska B, Nimer A, Maciejewski T, Sawicka E. (2023, Jun 30). Perinatal Outcomes of Neonates with Complex and Simple Gastroschisis after Planned Preterm Delivery-A Single-Centre Retrospective Cohort Study. Diagnostics (Basel). 13(13): 2225. https://doi.org/10.3390/diagnostics13132225; PMid:37443619 PMCid:PMC10340363

14. Kirollos DW, Abdel-Latif ME. (2018). Mode of delivery and outcomes of infants with gastroschisis: A meta-analysis of observational studies. Arch. Dis. Child. Fetal Neonatal Ed. 103: F355-F363. https://doi.org/10.1136/archdischild-2016-312394; PMid:28970315

15. Landisch RM, Yin Z, Christensen M, Szabo A, Wagner AJ. (2017). Outcomes of gastroschisis early delivery: A systematic review and meta-analysis. J. Pediatr. Surg. 52: 1962-1971. https://doi.org/10.1016/j.jpedsurg.2017.08.068; PMid:28947324

16. Lopez A, Benjamin RH, Raut JR, Ramakrishnan A, Mitchell LE, Tsao K et al. (2019). Mode of delivery and mortality among neonates with gastroschisis: A population-based cohort in Texas. Paediatr. Perinat. Epidemiol. 33: 204-212. https://doi.org/10.1111/ppe.12554; PMid:31087678 PMCid:PMC7028334

17. Nichol P et al. (2004). Meconium staining of amniotic fluid correlates with intestinal peel formation in gastroschisis. Pediatric Surgery International. 20(3): 211-214. https://doi.org/10.1007/s00383-003-1050-1; PMid:15083327

18. Nitzsche K, Fitze G, Rüdiger M, Birdir C. (2020). Prenatal Prediction of Outcome by Fetal Gastroschisis in a Tertiary Referral Center. Diagnostics. 10: 540. https://doi.org/10.3390/diagnostics10080540; PMid:32751744 PMCid:PMC7460378

19. Puligandla PS, Janvier A, Flageole H, Bouchard S, Laberge JM. (2004). Routine cesarean delivery does not improve the outcome of infants with gastroschisis. J. Pediatr. Surg. 39: 742-745. https://doi.org/10.1016/j.jpedsurg.2004.01.042; PMid:15137010

20. Shamshirsaz AA, Lee TC, Hair AB, Erfani H, Espinoza J, Shamshirsaz AA et al. (2020). Elective delivery at 34 weeks vs routine obstetric care in fetal gastroschisis: Randomized controlled trial. Ultrasound Obstet. Gynecol. 55: 15-19. https://doi.org/10.1002/uog.21871; PMid:31503365

21. Sliepov O, Migur M, Ponomarenko O et al. (2018). The Impact of Eventerated Organs Status on the Clinical Course and Prognosis of Simple Gastroshisis. Sovremennaya pediatriya. 1(89): 97-102. https://doi.org/10.15574/SP.2018.89.97

22. Sparks TN, Shaffer BL, Page J, Caughey AB. (2017). Gastroschisis: Mortality risks with each additional week of expectant management. Am. J. Obstet. Gynecol. 216: 66.e1-66.e7. https://doi.org/10.1016/j.ajog.2016.08.036; PMid:27596619