Gastroschiasis: Maternal/Neonatal characteristics, mortality and associated factors in Mulago Hospital.

Abstract

Introduction; Gastroschisis is a congenital anomaly characterized by a defect in the anterior abdominal wall through which abdominal contents protrude. Gastroschisis is increasing throughout the world for unknown reasons. This condition now occurs in about 1 of every 4,000 live births compared to years ago where it was 1 in 10 000, likewise in Uganda from review of medical records incidence is increasing. In developed countries mortality rate is less than 10%. The purpose of this study was to describe maternal and neonatal characteristics in Uganda and estimate the mortality. Methods; It was a prospective cohort study over one year where all mothers and babies who presented at Mulago hospital were enrolled consecutively and followed up for 30 days. Results ; 42 mothers and their gastroschisis babies were evaluated. Mortality was found at 97.6%. Most mothers were primiparas ( 40.5%),second parity (38.1%). The mean age was 21.8 years, less than 10% reported history of alcohol use, none of them smoked or used NSAIDs. Inhouse delivery was less than 10%, antenatal attendance was 92.9% but antenatal diagnosis was only 2.4%. Male to female ratio of babies born with gastroschisis was equal, 70% of the babies were low birthweight ( < 2.5kg) but term. 52.4% were breastfeeding at the time of arrival, 53.7% did not have an iv access, only 19% had their bowel well protected on arrival. 9.5% arrived with already gangrenous bowel. 58.3% of the babies arrived within 12 hours of delivery. Only 26.8% of the babies had deranged renal function tests. Only 21.4% of the babies had a surgery performed, 11.1% had primary closure surgery while 88.9% had an improvised silo. Conclusion ; Mortality of gastroschisis is alarmingly high. It’s more prevalent in primis and young mothers. Alcohol and smoking are not predisposing factors in Uganda in contrary to most western studies. Primary care of the babies is grossly lacking. Timely surgery and prenatal diagnosis were very low yet these greatly influence outcome.