Antenatal Fetal Diagnosis and Maternal Transport Gastroschisis

Abstract

Gastroschisis is a rare congenital birth defect of the abdominal wall that invariably is fatal if not managed appropriately. Early in utero diagnosis is now possible using maternal serum alpha-fetoprotein and ultrasound. As with other serious congenital disorders, antenatal diagnosis allows therapeutic options and time for preparation. Even if the diagnosis is made late, however, efforts to achieve prenatal maternal transport are still reasonable. The neonatal outcome of an unplanned delivery of an anomalous child requiring immediate attention is likely to be better if the delivery occurs in a tertiary center. These facilities generally have specialized services and teams available for critical care around the clock. The authors describe the maternal transport and delivery of a neonate with a serious disorder that required specialized attention at an hour when most hospitals are staffed with a skeleton crew. The necessary resources were available immediately, and the neonatal outcome was favorable. Although this report describes gastroschisis specifically, the concept of tertiary site delivery for potentially seriously ill neonates applies to any condition. With a late diagnosis, possible other anomalies, and a logistically unfavorable hour, the advantages of maternal transport are evident. This report also briefly reviews the area of antenatal ultrasound diagnosis and the newer mechanisms used to develop a perinatal care plan.