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Kviðarklofi á Íslandi 1970-1994

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Authors
Drífa Freysdóttir
Jóhann Heiðar Jóhannsson
Guðmundur Bjarnason
Issue Date
1999-05-01

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Other Titles
Gastroschisis in Iceland, a population study
Citation
Læknablaðið 1999, 85(5):408-13
Abstract
Introduction: Gastroschisis, a congenital abdominal wall defect, is a rare disorder. The incidence of gastroschisis in Iceland is neither known nor is the results of surgery. Objective: To determine the incidence of gastroschisis in Iceland, treatment results and mortality rate. Material and methods: A retrospective study was performed. Hospital records, birth records and autopsy records were reviewed. The period was divided in two, 1970-1982 and 1983-1994. Results: Twenty-eight children with gastroschisis were born in Iceland 1970-1994. Ten children with gastroschisis were born in the first period and 18 in the second, making the incidence 1.78/10,000 births vs. 3.45/10,000 (p<0.09). No abortion was performed because of gastroschisis and no child was stillborn with it. Associated anomalies were detected in 13 children, eight of which were gut atresias or stenosis. Other anomalies were found in seven children (21.4%). Of the mothers 82% (23/28) were primiparous, mean age 21.5 years. Gestational age was 30-40 weeks. Vaginal delivery was in 16 cases and Caesarean section in 12 cases, six of which were elective. Eighteen children were diagnosed at birth, 10 by ultrasound at 19 weeks of gestations. Birth weight was 2650 g (mean, range 1500-3720 g). Primary closure was done in 15 cases and delayed closure in 11, mostly in the first period. Hospital stay was 55 days (mean, median 26 days). Mortality rate was 10.7% (3/28) in two cases associated with major congenital anomalies. Long term complications are few 5/28 and consist of recurrent abdominal pain and constipation. Conclusions: This study indicates that the incidence of gastroschisis is increasing in Iceland, and although the study is too small to be significant, the trend is obviously there. In accordance with other studies the predominance of young primiparous mothers and small for gestational age children is observed. The results in treating gastroschisis in Iceland is at least as good as in bigger centers and the mortality rate is well within acceptable range, especially if taken into account that no abortions were performed because of gastroschisis.
Inngangur: Kviðarklofi er sjaldgæfur, meðfæddur galli á kviðvegg. Tíðni hans á Íslandi er ekki þekkt né árangur meðferðar. Markmið: Að ákvarða tíðni kviðarklofa á Íslandi, meðgöngusögu (meðgöngulengd, aldur mæðra, fjölda fyrri meðgangna), árangur meðferðar og lifun. Efniviður og aðferðir: Afturskyggn rannsókn var gerð. Farið var yfir sjúkraskrár, fæðingarskrár og krufningarskýrslur. Tímabilinu var skipt í tvennt, 1970-1982 og 1983-1994. Niðurstöður: Tuttugu og átta börn með kviðarklofa fæddust á íslandi 1970-1994 . Tíu börn fæddust með kviðarklofa á fyrra tímabilinu og 18 börn á síðara tímabilinu. Útreiknuð tíðni var 1,78/10.000 fæðingar á fyrra tímabilinu en 3,45/10.000 fæðingar á því síðara (p=0,09). Engin fóstureyðing var framkvæmd vegna kviðarklofa og ekkert barn fæddist andvana. Aðrir fæðingargallar fundust hjá 13 börnum, þar af garnalokun eða -þrengsli hjá átta. Sjö börn höfðu fæðingargalla utan meltingarvegar (21,4%). Af mæðrum voru 82% (23/28) frumbyrjur, meðalaldur var 21,5 ár. Meðgöngulengd var 30-40 vikur. Sextán börn fæddust með eðlilegum hætti en 12 með keisaraskurði, þar af sex með bráðakeisara. Átján börn greindust við fæðingu en 10 með ómun á 19. viku meðgöngu. Fæðingarþyngd var 2650 g (bil 1500¬3720 g). Kviði var lokað í einni aðgerð hjá 15 börnum, en í tveimur aðgerðum hjá 13 börnum. Legutími var 55 dagar (miðtala 26 dagar; bil 14-351 dagur). Dánatíðni var 10,7% (3/28). Langtímafylgikvillar voru fáir 5/28, aðallega endurtekin kviðverkjaköst og hægðatregða. Ályktanir: Rannsókn þessi gefur til kynna að tíðni kviðarklofa geti verið að aukast á Íslandi en rannsóknin er of lítil til að sú aukning geti orðið marktæk. Ungur aldur mæðra og það að börnin eru yfirleitt frumburðir er í samræmi við niðurstöður annarra rannsókna. Arangur meðferðar vegna kviðarklofa hér á landi er eins og best verður og dánartíðni er lág.
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