Methodology of prenatal ultrasound examinations in gastroschisis

Background. Gastroschisis is a complex malformation with significant anatomic and clinical variability. At present, it is not enough just to make a prenatal diagnosis – it is necessary to perform detailed repeated evaluation of the pathological process in order to assess its severity and prognosis, and to adjust accordingly management of pregnancy, labor and neonatal period. Purpose – to propose a methodology/algorithm of prenatal ultrasound examinations in gastroschisis, taking into account the most common associated anomalies, anatomical variants and characteristic changes during pregnancy. Materials and methods. Data on prenatal ultrasound examinations of 175 pregnant women with fetal gastroschisis conducted during the period 2007–2020 were systematized, and also compared with clinical/surgical postnatal data in 74 cases. Ultrasound examinations were performed on the HDI 4000, ACCUVIX V20EX-EXP, ACCUVIX V10LV-EX systems, following extended protocol. Results. Prenatal ultrasound semiotics of gastroschisis changes significantly during the pregnancy, that requires repeated exams and evaluation. Typical and rare variants of abdominal organs eventration are characterized, the main structures for detailed assessment are outlined considering clinical significance of the most common findings. Methodology of prenatal ultrasound examination of fetuses with gastroschisis is proposed that takes into account its pathological anatomy and ultrasound semiotics. It also includes correct measurement of abdominal cavity and eventrated organs, calculation of index for evaluation of the degree of viscero-abdominal disproportion, which help to determine the severity of the pathology. Conclusions. Proposed methodology of prenatal ultrasound examination in gastroschisis allows to perform systematic assessment, to establish a complete correct prenatal diagnosis, to determine severity of the pathology and its prognosis, which are necessary for adequate choice of patientsʼ management strategy.