Prenatal Diagnosis of Antenatal Midgut Volvulus: Specific Ultrasound Features

Study Overview
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Brief Summary
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Objective: The small bowel volvulus is a rare cause of intestinal obstruction which may occur in utero and whose prenatal diagnosis is difficult.Sonographic signs are mainly indirect and non specific.The aim of this study is to present a retrospective analysis of prenatal sonographicfindings in fetal segmental midgut volvulus.Thanks to this series the investigators could highlight the more specifics signs of the volvulus included a new pattern.

Detailed Description
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Objective: The small bowel volvulus is a rare cause of intestinal obstruction which may occur in utero and whose prenatal diagnosis is difficult. Sonographic signs are mainly indirect and nonspecific. The aim of this study is to present a retrospective analysis of prenatal sonographic findings in fetal segmental midgut volvulus. Thanks to this series the investigators could highlight the more specifics signs of the volvulus included a new pattern. Methods: Unicentric retrospective analysis of cases of prenatal midgut volvulus between 2006 and 2017. The primary inclusion criteria was postnatal diagnosis of prenatal volvulus based on post-natal findings and prenatal imaging findings. The exclusion criteria was the absence of prenatal imaging assessment. The investigators collected the clinical history and the echographic mode B and color Doppler. They have searched for some specific sign like  whirlpool sign  representing the winding of the mesenteric vein around the superior mesenteric arterywith color Doppler with arciform pattern of the midgut, hydro-meconium level in the dilated loops and position of mesenteric vessels for evaluation of the intestinal (mal) rotation. Gold standard was surgery or foetopathology if performed.

Official Title
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Prenatal Diagnosis of Antenatal Midgut Volvulus: Specific Ultrasound Features

Conditions
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Fetal Volvulus, Midgut Volvulus

Intervention / Treatment
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* Other: Fetal ultrasound during the second or third trimester/ Postnatal surgery / Post mortem examination


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: postnatal diagnosis of prenatal volvulus based on post-natal findings and prenatal imaging findings Exclusion Criteria: the absence of prenatal imaging assessment

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pregnant patients seen for second or third trimester<br>Foetus with diagnosis of prenatal volvulus based on post-natal findings and prenatal imaging findings | Other: Fetal ultrasound during the second or third trimester/ Postnatal surgery / Post mortem examination<br>* Fetal ultrasound during the second or third trimester Postnatal surgery Post mortem examination<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| echography | Observation of specific signs using echography for the diagnosis of fetal during the second (22-24 weeks) and the third (31-34 weeks) trimester after ultrasound screening and when diagnostic ultrasound were performedmidgut volvulus | during the second (22-24 weeks) after ultrasound screening | 
| echography | Observation of specific signs using echography for the diagnosis of fetal | the third (31-34 weeks) trimester after ultrasound screening | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ultrasound signs of complication | Observation of ultrasound signs of complication of midgut volvulus during the pregnancy like meconial pseudocyst, ascites, meconial peritonitis. | the third (31-34 weeks) after ultrasound screening | 
| ultrasound signs of complication | Observation of ultrasound signs of complication of midgut volvulus during the pregnancy like meconial pseudocyst, ascites, meconial peritonitis. | during the second (22-24 weeks) after ultrasound screening | 
| ultrasound signs of complication | Observation of ultrasound signs of complication of midgut volvulus during the pregnancy like meconial pseudocyst, ascites, meconial peritonitis after diagnostic ultrasound. | 1 day | 
| ultrasound signs of complication | Observation of ultrasound signs of complication of midgut volvulus during the pregnancy like meconial pseudocyst, ascites, meconial peritonitis. | just after delivery | 
| presence or not of the volvulus | Observation of surgery outcome like presence or not of the volvulus after diagnostic ultrasound | 1 day | 
| presence or not of the volvulus | Observation of surgery outcome like presence or not of the volvulus | during the second (22-24 weeks) after ultrasound screening | 
| presence or not of the volvulus | Observation of surgery outcome like presence or not of the volvulus | just after delivery | 
| presence or not of the volvulus | Observation of surgery outcome like presence or not of the volvulus | the third (31-34 weeks) after ultrasound screening | 
| presence or not ileal atresia. | Observation of surgery outcome like presence or not ileal atresia | during the second (22-24 weeks) after ultrasound screening | 
| presence or not ileal atresia. | Observation of surgery outcome like presence or not ileal atresia | the third (31-34 weeks) after ultrasound screening | 
| presence or not ileal atresia. | Observation of surgery outcome like presence or not ileal atresia | just after delivery | 
| presence or not ileal atresia. | Observation of surgery outcome like presence or not ileal atresia after diagnostic ultrasound | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Midgut volvulus, Fetal volvulus, Whirlpool sign, Pregnant women, Position of mesenteric vessels, Post natal surgery, Foetopathology if performed, Hydro-meconium level in the dilated loops