[size=20px]You are asked to see a couple with a fetus that has a 30-week ultrasound that reveals an apparent omphalocele.

 

In counseling the family, the finding most associated with a poor outcome in omphalocele is

 

A maternal age.

 

B polyhydramnios.

 

C liver herniation.

 

D small bowel dilation.

 

E ratio of omphalocele to transverse abdomen diameter of 0.5.[/size]

C

C

correct

 

Polyhydramnios and oligohydramnios may sometimes be seen in association with abdominal wall defects but have not been shown to be independent predictors of outcome. Small bowel dilation, more likely in gastroschisis than omphalocele, could indicate an intestinal abnormality although there is no evidence that this finding predicts outcome. Prenatal diagnosis itself is not a marker for poor outcome.

 

A ratio of omphalocele to abdominal transverse diameter of less than 60% may indicate a smaller defect which contains bowel and not liver. The ratio of the transverse area of the lung to the thorax may predict associated pulmonary hypoplasia in a giant omphalocele.

 

Several studies have identified prenatal ultrasound findings of liver herniation in an omphalocele as a predictor of increased morbidity and mortality. This may simply be related to liver herniation being a marker for a larger defect. Some reports have noted this finding to be associated with an increased risk of other major associated anatomic anomalies while smaller defects are more commonly associated with chromosomal anomalies.

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c