Congenital small bowel obstruction: Prenatal detection and outcome

ObjectiveTo evaluate and compare the outcome of fetuses and neonates with congenital small bowel obstructions (SBO), evaluate the screening performance of prenatal ultrasound for SBO and identify possible risk factors for adverse outcomes.MethodsAll cases referred to the Amsterdam University Medical Centers between 2007 and 2021 for a prenatal suspected SBO, supplemented by cases of postnatal diagnosis of SBO, were included. The primary outcome was survival after 24 weeks of gestation until the first year of life.Results147 cases of SBO were included with a survival rate of 86.2% (119/138) after 24 weeks of gestation until the first year of age. Additional structural or chromosomal anomalies were found to have an increased risk of adverse outcomes. Intrauterine fetal demise occurred in 10/147 (6.8%) cases and 9/147 (6.1%) cases died during postnatal follow-up. The overall positive predictive value of all prenatally diagnosed cases was 91.5%. Surgical correction was performed in 123/128 (96.0%) of the live-born cases.ConclusionsCongenital SBO has an overall favorable prognosis, but the outcome is negatively impacted by the possible presence of additional structural or chromosomal anomalies. Fetal monitoring in the early third trimester should be considered, since all cases of Intrauterine fetal demise occurred between 30 and 35 weeks of gestation. What's already known about this topic?Congenital small bowel obstruction (SBO) is typically a late onset anomaly visible on fetal ultrasound in the late second or third trimester. The prognosis is influenced by co-existence of chromosomal and additional structural anomalies: About 50% have other associated structural anomalies and one-third of the neonates with duodenal atresia have trisomy 21.What does this study add?In fetuses with a SBO, survival after 24 weeks of gestation to the first year of age was 86.2%. Intrauterine fetal demise (IUFD) within this cohort occurred between 30 and 35 weeks of gestation, predominantly in cases with duodenal obstruction. This suggests that fetal monitoring through ultrasound and cardiotocography should be considered from 30 weeks of gestation onwards.

Automated summary

Fetuses with congenital small bowel obstructions (SBO) have a favorable prognosis overall, but the presence of additional structural or chromosomal anomalies negatively impacts the outcome. Fetal monitoring should be considered in the early third trimester, as all cases of intrauterine fetal demise occurred between 30 and 35 weeks of gestation.