Abdominal wall defects Flashcards
Anomalies associated with Pentalogy of Cantrell
Not every case will have all 5 abnl, and some cases may have assoc anomalies, usually midline defects such as cleft lip/palate, sirenomelia, exencephaly
Heart position in Pentalogy of Cantrell vs ectopia cordis
Heart in PoC is normally positioned within the chest, but with a subtle shift in axis.
Most common heart abnormality in Pentalogy of Cantrell, others?
Most common = VSD
Others = ASD, pulmonic stenosis, ToF, LV diverticulum
Other anomalies associated with Pentalogy of Cantrell
Vertebral and digital anomalies, including kyphoscoliosis and clinodactyly
Craniofacial - encephalocele, cleft lip, microphthalmia, low set ears
2VC
Absent left lung
Cloacal exstrophy
Fetal ascites
Ddx of Pentalogy of Cantrell
Ectopia cordis
Body-stalk anomaly
Simple omphalocele
Amniotic band syndrome
Management of pregnancy w/ Pentalogy of Cantrell
Estimate size and contents of omphalocele
Careful sono exam for other abnl
Karyotype
Surveillance for IUGR, PTL, rupture of omphalocele membrane
Reserve cesarean for obstetric indications, or if giant omphalocele
Genetics of Pentalogy of Cantrell
Primarily thought to be sporadic
Chrom abnl not usual, but abnl in 13 & 18 reported
Possible X-linked
What is an omphalocele?
Defect in ventral abdominal wall characterized by absence of abdominal muscles, fascia, skin. Defect is covered by a membrane that consists of peritoneum and amnion.
Where does the umbilical cord insert in omphalocele?
Insets into the membrane at a location distant from the abdominal wall.
Why and when does omphalocele occur?
Abnormality during process of body infolding at 3-4 weeks gestation.
Incidence of omphalocele
1/4000-7000 livebirths, 1/300-400 combined livebirths & stillbirths
Epidemiology of omphalocele
Associated with AMA
Ruptured omphalocele vs gastroschisis
Defects are usually larger with ruptured omphalocele and have at least exposed, if not extracorporeal, liver
What is Beckwith-Wiedemann syndrome?
Aka exomphalos-macroglossia-gigantism syndrome. Consists of omphalocele, visceromegaly, macroglossia, and severe neonatal hypoglycemia.
Cardiac abnl frequent.
Malignant tumors in 10% - Wilm’s tumor, hepatoblastoma, adrenal tumors
Macroglossia & visceral enlargement rarely seen prior to 3rd trimester.
Frequency of visceral malformations with omphalocele
50-70% of cases
Frequency of chromosomal abnl w/ omphalocele
30-60%
The absence of liver in the omphalocele increases or decreases the likelihood of chromosomal abnl & perinatal mortality?
Interestingly, it increases the likelihood. (In other words, small defects are associated with an increased risk of chromosomal abnl).
Predominant chromosomal abnl w/ omphalocele
T18 (17 of 19 cases w/ chrom abnl in one series)
Risk of chromosomal abnl in central vs epigastric omphalocele
Central - 70%
Epigastric - 12%
Risk of associated anomalies in omphalocele
65% of 349 cases detected antenatally
Risk of associated anomalies in omphalocele w/ a nl karyotype
56.00%
Incidence of associated congenital heart disease w/ omphalocele
25.00%
Does MSAFP have a higher sensitivity for omphalocele or gastroschisis?
Much higher for gastroschisis (for cutoff of >2.5 MoM and >3.0 MoM, detection rates were 98% and 96% for gastroschisis, and 71% and 65% for omphalocele).
Management of pregnancy w/ omphalocele
Estimate size and contents of omphalocele, location of cord insertion relative to herniation, presence of amnioperitoneal membrane
Careful sono exam for other abnl, including fetal echo
Chromosomal analysis
Consultation with pedi surgery, genetics, neonatology, pedi cards
Surveillance for IUGR (6-35%) & PTL (25-65%), and for omphalocele rupture
