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Gastroschisis

Fetal pregnancy complications


Video

Types of Abdominal Wall Defects : Explaining Gastroschisis and Omphalocele

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Description

Gastroschisis, also called laparoschisis, is a birth defect of the abdominal wall that causes an opening through which the baby’s intestines can extend out into the amniotic fluid. In most cases, this opening is to the right of the umbilicus. There is no membrane surrounding the intestines, which distinguishes it from omphalocele.

Gastroschisis affects about 5 live births out of 10,000.


Causes

The causes of gastroschisis are unclear. Two hypotheses have been suggested though not proven: poor vascularity of one of the umbilical cord vessels, which causes damage to the mesenchymal (embryonic connective tissue that envelops organs); and weakening of the abdominal wall. Young maternal age, smoking, drug use, and low socio-economic status are key factors associated with the development of gastroschisis.

The risk of developing gastroschisis is 16 times greater before 20 years of age than above 30.


Symptoms to monitor

Depending on the progression of the condition, regular and frequent ultrasounds are recommended to monitor fetal growth, amniotic fluid level, and most importantly the appearance of intestinal distension.


Tests and procedures

It is possible to see gastroschisis on ultrasound in the first trimester.

Reference to a tertiary centre such as CHU Sainte-Justine is recommended to confirm the diagnosis. Further examinations may be requested (like fetal echocardiography) to ensure that the abnormality is isolated. Amniocentesis is not usually offered by the genetic team since no chromosome abnormalities are involved in this anomaly.


Treatment and follow-up care

Pregnancy monitoring and delivery must be done at a specialized centre like the CHU Sainte-Justine.

The care of the mother and child is carried out by a multidisciplinary team that includes an obstetrician specializing in fetal-maternal medicine, a geneticist, a pediatric surgeon, a neonatologist pediatrician, and a radiologist. Several other professionals may also be part of the team depending on the specific needs in each case (for example, a psychologist or a lactation consultant).

The mode of delivery is planned according to the clinical conditions of both mother and child. Although a vaginal delivery is possible, a caesarean section may be recommended, depending on the obstetric conditions. A birth is usually expected around the 37th week of pregnancy, but it is common for a preterm birth to occur.

When the baby is born, the neonatal team takes immediate action to preserve and protect the intestinal tissue from dehydration.

There are two ways of putting the intestines back inside the newborn’s abdomen, depending on how long the intestines outside of the abdomen are:

  • Surgically returning the loops to the peritoneal cavity and closing the abdominal wall.
  • Placing the intestines in a silo bag and letting them naturally reposition themselves in the peritoneal cavity.

The duration of hospitalization is approximately 30 days.


Resources and useful links

Robert K. Creasy, Robert Resnik et coll. Creasy & Resnik’s Maternal-Fetal Medecine : Principle and Practice. 7e ├ędition, Elsevier Canada, 2014.

Fiche par

Chantal Larcher, inf. clinicienne et Dre Lucie Morin

About this page
Updated on 12/19/2017
Created on 12/18/2017
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