Re: Gastroschisis
From: Amanda (anonymous@obgyn.net)
Mon, 11 Feb 2002 11:33:48 -0600 (CST)
Gastroschisis is rare, about 1/10,000 pregnancies. About one third of
affected pregnancies have other anomalies including genitourinary,
cardiac, and musculoskeletal abnormalities. Preterm labor is common,
but for those babies without associated defects and who weigh more than
1500 grams at birth, the prognosis is very good, as long as surgical
repair is carried out immediately after birth.
--
William D. McIntosh, MD, FACOG
A gastroschisis is a small defect in the baby's abdomen, usually not too
far from the belly button. The cause for the defect is unclear but may
be related to an interuption of blood supply to that small area of the
abdominal wall early in the development of the embryo. Greater than 95%
of outcomes in babies with a gastroschisis are good. The baby will need
a surgical procedure following delivery to replace the bowel back into
the baby's abdomen and repair the defect. Occasionally, there is a need
to do some resecting of some of the bowel, but not usually. Sometimes,
the bowel replacement has to be done in a staged fashion (more than one
procedure) because of the fact that the small bowel has been outside the
abdominal wall during intrauterine development, and because of this the
abdominal cavity in some cases does not have enough room. Things to
follow are whether or not the stomach or liver begin to herniate out of
the abdominal wall. If this happens, it worsens the outcome-this
usually doesn't happen. Also, it will be important for the delivery to
occur where there is a surgeon comfortable with this sort of procedure.
It doesn't have to be a pediatric surgeon, but they need to be familiar
with the procedure. Finally, unless the liver or stomach are herniated
out, the delivery should be vaginal. There is no indication for
cesarean section outside of the normal indications. In other words,
doing a cesarean doesn't improve the outcome of the gastroschisis
repair.
--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana
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