Prevention of pathological changes of eventerated organs in gastroschisis in fetuses and newborns
DOI:
https://doi.org/10.15574/PP.2024.3(99).104108Keywords:
gastroschisis, fetus, intestinal lesions, prevention, cesarean section, premature deliveryAbstract
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.
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