Gastroschisis: growth patterns and a proposed prenatal surveillance protocol.

OBJECTIVE: To assess intrauterine growth for fetuses with gastroschisis using retrospective serial ultrasound assessment from fetuses diagnosed prenatally with gastroschisis. The growth assessment could be available as a prospective tool to direct an antepartum fetal surveillance protocol. METHODS: This is a retrospective review of all cases of gastroschisis evaluated prenatally at a single institution between February 1996 and March 2002. Charts were reviewed for serial ultrasound assessment, gestational age at delivery, mode of delivery, and birth weight. Growth assessment was determined for abdominal circumference, biparietal diameter, head circumference, femur length, and estimated fetal weight (IRB No. 2002-1-2648). RESULTS: Forty patients had delivered by March 2002. One hundred and two ultrasound reports were reviewed. Gastroschisis growth curves showed that the 50th percentile was shifted to the right when compared to normal growth curves for abdominal circumference, biparietal diameter, head circumference, and femur length. The average birth weight was 2,359 g. Compared with a standard population, 44% (16/36) were below the 5th percentile, 61% (22/36) were below the 10th percentile, and 95% (34/36) were below the 50th percentile for gestational age. The average gestational age at delivery was 36.3 weeks. Mothers were nulliparous in 78%, with a mean age of 21.3 years. CONCLUSIONS: (1) Fetuses with gastroschisis show a symmetric intrauterine growth restriction pattern consistent with early development of growth delay; (2) the 50th percentile biometry measurements for the gastroschisis population are shifted to the right on normal fetal growth curves; (3) the birth weight is at or below the 10th percentile in 61% of the newborns with gastroschisis, and (4) an antepartum surveillance protocol is proposed based on growth patterns of fetuses with gastroschisis.

Polymorphism of Fas and Fas ligand in preterm premature rupture of membranes in singleton pregnancies.

OBJECTIVE: Fetal inflammatory response has been previously shown to be involved in the pathogenesis of preterm premature rupture of membranes. We investigated the association between polymorphisms at position -670 in the Fas gene and position -124 in the Fas ligand gene demonstrated in neonatal oral mucosa cells and preterm premature rupture of membranes. STUDY DESIGN: Thirty-six singleton pregnancies were studied. Eighteen pregnancies were complicated by preterm premature rupture of membranes, and 18 were delivered at term without preterm premature rupture of membranes. Buccal swabs were obtained from each neonate, and extracted deoxyribonucleic acid was analyzed by polymerase chain reaction-based restriction fragment length polymorphism for an adenine (A) to guanine (G) substitution at position -670 in the Fas promoter gene and at position -124 in the Fas ligand gene. chi2 and Fisher's exact tests were used for statistical analysis. RESULTS: There was no difference with respect to race, maternal age, and parity between the 2 groups. Frequencies of Fas -670 AG, -AA, and -GG genotypes in preterm premature rupture of membranes group were significantly different from those in the control group (P = .004). The frequency of the heterozygous AG genotype was significantly higher in preterm premature rupture of membranes group as compared with controls (83.3% versus 33.3%, P = .003). Fas -670 AA genotype was not observed among patients with preterm premature rupture of membranes. Similarly, the difference of frequencies of the Fas ligand -124 AG, -AA, and -GG genotypes among preterm premature rupture of membranes group and controls was observed but did not reach statistical significance. Neither of the groups demonstrated homozygous GG genotype at position -124 of the Fas ligand gene. CONCLUSION: Our data indicate an association between preterm premature rupture of membranes and increased prevalence of neonatal AG genotype at -670 Fas promoter gene. Genetically predetermined regulation of the Fas/Fas ligand system appears to play an important role in the pathogenesis of the preterm premature rupture of membranes.