Prenatal ultrasound diagnosis of anterior abdominal wall defects in sub Saharan Africa; simple but often missed

Andrew H. Shitta, Mercy W. Isichei, Ezekiel D. Dung, Solomon D. Peter, Michael B. Ode, Isaac A. Jatau, Onyedikachi N. Ottah, Alexander F. Ale


Background: Congenital anterior abdominal wall defects (AAWD) is a spectrum of abdominal wall defects that includes omphalocele, gastroschisis, bladder exstrophy, cloacal exstrophy, prune belly syndrome and pentalogy of Cantrell. Early Prenatal diagnosis of AAWD provides opportunity for abnormal karyotypes screening and planned delivery in a specialized centre. Ultrasound can detect these defects during pregnancy. This study aims to evaluate the detection rate of AAWD during routine obstetric ultrasonography in our region.

Methods: A retrospective study of all patients that presented with AAWD to our centre from January 2008 to July 2020. Data included patient’s age, sex, birth weight, diagnosis, resuscitation time, outcome, maternal age, parity and antenatal ultrasound scan (USS) records. Antenatal USS before 12 weeks only, were excluded. Data analysed using excel.

Results: Of the 140 with AAWD, 84.29% had omphalocele, 10% gastroschisis, 2.14% prune belly syndrome and 0.71% each with bladder exstrophy, cloacal exstrophy and pentalogy of Cantrell. There were 123 booked pregnancies. Majority (112) had antenatal care elsewhere while 11 attended our Centre. Ultrasonography of 108 pregnancies scanned at12 weeks or beyond, had 4 confirmed prenatal diagnosis of AAWD. All done in our centre. Mean gestational age at diagnosis was 24weeks. Outcome was rupture1 (25%) and 25% mortality (prenatally diagnosed) and 51.92% mortality for patients with missed diagnosis.

Conclusions: Our obstetric ultrasound detection rate of AAWD is very low. There is a need for improvement in training to improve perinatal care of these defects.


Prenatal diagnosis, Ultrasonography, Anterior abdominal wall defects

Full Text:



Djakovic A, Blissing S, Volker HU, Dietl J. Body stalk anomaly--a case report on a rare congenital defect. Zentralbl Gynakol. 2006;128(6):369-71.

Sygelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides K. Challenges in the diagnosis of fetal non-chromosomal abnormalities. Prenat Diagn. 2011;31:90-102.

Barisic I, Clementi M, Häusler M, Gjergja R, Kern J, Stoll C. Evaluation of prenatal ultrasound diagnosis of fetal abdominal wall defects by 19 European registries. Ultrasound in Obstetrics and Gynecology: Official J Int Soc Ultrasound Obstet Gynecol. 2001;18(4):309-16.

Brantberg A, Blaas HG, Haugen S, Eik‐Nes S. Characteristics and outcome of 90 cases of fetal omphalocele. Ultrasound in Obstetrics and Gynecology: Official J Int Soc Ultrasound Obstet Gynecol. 2005;26(5):527-37.

Agarwal R. Prenatal diagnosis of anterior abdominal wall defects: Pictorial essay. Ind J Radiol Imag. 2005;15(3):361.

Prefumo F, Izzi C. Fetal abdominal wall defects. Best practice & research Clinical obstetrics & gynaecology. 2014;28(3):391-402.

Robertson JA, Kimble RM, Stockton K, Sekar R. Antenatal ultrasound features in fetuses with gastroschisis and its prediction in neonatal outcome. Aust N Zealand J Obstet Gynaecol. 2017;57(1):52-6.

Ergenoğlu MA, Yeniel AÖ, Peker N, Kazandı M, Akercan F, Sağol S. Prenatal diagnosis of Cantrell pentalogy in first trimester screening: case report and review of literature. J Turk German Gynecol Assoc. 2012;13(2):145.

Desselle C, Herve P, Toutain A, Lardy H, Sembely C, Perrotin F. Pentalogy of Cantrell: sonographic assessment. J Clinic Ultrasound. 2007;35(4):216-20.

Mirk P, Calisti A, Fileni A. Prenatal sonographic diagnosis of bladder extrophy. J Ultrasound Med. 1986;5(5):291-3.

Kutzner DK, Wilson WG, Hogge WA. OEIS complex (cloacal exstrophy): prenatal diagnosis in the second trimester. Prenatal diagnosis. 1988;8(4):247-53.

Chen L, Cai A, Wang X, Wang B, Li J. Two‐and three‐dimensional prenatal sonographic diagnosis of prune‐belly syndrome. J Clinic Ultrasound. 2010;38(5):279-82.

Matos APP, Duarte LdB, Castro PT, Daltro P, Werner Júnior H, Araujo Júnior E. Evaluation of the fetal abdomen by magnetic resonance imaging. Part 2: abdominal wall defects and tumors. Radiologia brasileira. 2018;51(3):187-92.

Wanyonyi SZ, Mariara CM, Vinayak S, Stones W. Opportunities and challenges in realizing universal access to obstetric ultrasound in sub-Saharan Africa. Ultrasound international open. 2017;3(2):E52.

Christison-Lagay ER, Kelleher CM, Langer JC, editors. Neonatal abdominal wall defects. Seminars in Fetal and Neonatal Medicine; 2011: Elsevier.

Brinkhoff, T. 2020. 032,026,005,007,019. Accessed 29 May, 2021.

National Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF.

Kamla I, Kamgaing N, Billong S, Tochie JN, Tolefac P, de Paul Djientcheu V. Antenatal and postnatal diagnoses of visible congenital malformations in a sub-Saharan African setting: a prospective multicenter cohort study. Bio Med Cent Pediat. 2019;19(1):1-9.

Abdur-Rahman LO, Abdulrasheed NA, Adeniran JO. Challenges and outcomes of management of anterior abdominal wall defects in a Nigerian tertiary hospital. Afr J Paediat Surg. 2011;8(2):159.

Boyd P, Bhattacharjee A, Gould S, Manning N, Chamberlain P. Outcome of prenatally diagnosed anterior abdominal wall defects. Archives of Disease in Childhood-Fetal and Neonatal Edition. 1998;78(3):F209-13.

Nasr A, Langer JC, Network CPS. Influence of location of delivery on outcome in neonates with gastroschisis. J Pediat Surg. 2012;47(11):2022-5.

Apfeld JC, Wren SM, Macheka N, Mbuwayesango BA, Bruzoni M, Sylvester KG, et al. Infant, maternal, and geographic factors influencing gastroschisis related mortality in Zimbabwe. Surgery. 2015;158(6):1475-80.

Stevens P, Muller E, Becker P. Gastroschisis in a developing country: poor resuscitation is a more significant predictor of mortality than postnatal transfer time. South Afr J Surg. 2016;54(1):4-9.