The Fetal Center
Gastroschisis Prenatal Care Algorithm
Gastroschisis occurs when intestines and possibly other organs are located outside of the abdomen due to a hole in the fetal abdominal wall. The severity depends upon how much of the intestines and/or organs have moved through this hole.
Gastroschisis occurs in approximately one in every 2,000 live births and the incidence appears to be increasing.
In mild cases, only small portions of intestine are outside of the abdomen. Most of the organs develop normally. In some cases, portions of the intestine can develop improperly. Because the bowel is free to float in the amniotic fluid, the intestines can twist and develop kinks, blockages, or separations. When this happens, the infant can be born with only a short segment of working bowel. This can be a significant problem that can only be determined after birth. Your pediatric surgeon will discuss these issues if they are suspected.
The cause of gastroschisis is unknown. This condition does not run in
families. Most infants with gastroschisis do not have chromosomal or
genetic syndromes, but sometimes may result in low birthweight, preterm
delivery, and stillbirth. Although both are abdominal wall defects,
gastroschisis differs significantly from an omphalocele. Please see omphalocele to learn these differences.
can be detected by ultrasound from about the third month of pregnancy.
Once the condition has been detected, a series of ultrasounds will be
performed throughout pregnancy to evaluate the fetal bowel and to assess
fetal growth. Sometimes a specialized ultrasound of the fetal heart,
called an echocardiogram, will be performed. Antenatal testing is
usually initiated in the third trimester.
There is no fetal intervention available for gastroschisis.
Type of delivery - Gastroschisis
does not always require cesarean delivery. The delivery plan should be
carefully discussed between the mother and her obstetrician.
Place of delivery - The baby should be delivered at a
hospital that is well prepared to handle the intensive care and surgery
required of infants with gastroschisis. There should be a neonatal
intensive care unit with the capability to provide specialized care and
pediatric surgery services.
Time of delivery - There is usually no reason for early
delivery of babies with gastroschisis. Babies will benefit from being
allowed to reach full gestational maturity, if possible. Sometimes early
delivery is recommended if the baby is not growing well inside the
Immediately following delivery, doctors will carefully evaluate the baby and start treatment. After a brief period with mom and family, the baby will be transferred
to the neonatal intensive care unit. A pediatric surgeon will see and
evaluate your baby. The baby will be stabilized in an intensive care
unit and, depending on the size of the hole in the abdominal wall a
protective pouch (silo) may be placed over the exposed intestines and/or
organs to protect them from infection and/or damage.
Once the baby
has stabilized, a pediatric surgeon will surgically repair the
gastroschisis. Depending on the size of the hole in the abdominal wall
and the amount of intestines and/or organs that are exposed, this
surgery may take place within days or weeks of delivery. Sometimes there
is too much inflammation and swelling of the bowel to safely place them
back into the abdomen. In these situations, a temporary pouch or silo
will be used to protect the intestines. Over the course of the next few
days, the surgical team will re-evaluate the bowel. As the swelling goes
away and the intestines shrink, the gastroschisis may be repaired. The
timing of the surgery will be determined by your pediatric surgeon.
After the gastroschisis is repaired, it may be several weeks before
the baby’s intestinal tract functions normally. Because the intestines
have been very swollen and inflamed, the intestines will not be ready to
handle food immediately. Before any attempts at feeding, the baby must
show that proper GI function has returned. In the meantime, the baby
will be provided IV nutrition through total parenteral nutrition (TPN).
almost all cases of gastroschisis, the long-term prognosis is
excellent. Most babies will recover to lead a normal life with no
complications. Some babies with gastroschisis will be born with a
blockage or atresia which would require additional surgery. In a small
percentage of cases, babies experience prolonged intestinal problems and
some may have issues with bowel function especially those that have a
short amount of intestine. If this occurs, your doctors will discuss the
long-term plans in caring for your child.
Contact The Fetal Center to make an appointment with a high-risk pregnancy doctor.
Note: This information regarding your condition is meant to be a
helpful, informative introduction. Because every newborn is different,
this may not be applicable to all cases, especially if there are
additional defects. Your team of experts at the Center will provide you
with information specific to your pregnancy.
For immediate assistance,call 832.325.7288 or toll free at 1.888.818.4818