Management of Gastroschisis

Abstract

After completing this article, readers should be able to: 1. Describe various aspects of prenatal management for pregnancies complicated by gastroschisis, including diagnosis and counseling. 2. Know the increased risk of third trimester complications in pregnancies with gastroschisis and the need for close monitoring and vigilance during the perinatal period. 3. Discuss the controversial management strategies regarding timing and mode of delivery in gastroschisis and the resolution of some of the ongoing debates. 4. Delineate the important aspects of neonatal management of gastroschisis, including enumeration of modalities of surgical repair and postoperative complications. 5. Discuss the need for multicenter prospective controlled trials to standardize care of infants who have gastroschisis and improve outcomes. Gastroschisis is a common neonatal congenital anomaly whose global prevalence is increasing. Although survival of affected infants has improved over the past several decades, the relationship among prenatal diagnosis, the resulting perinatal management (including timing and mode of delivery), and timing and type of neonatal surgery remain uncertain. Over the past several years, a number of clinical and animal studies have clarified some aspects of the confusion. ### Diagnosis Gastroschisis is diagnosed prenatally via ultrasonography that documents the ventral abdominal wall defect through which loops of bowel protrude and float freely in the amniotic fluid. The umbilical cord insertion site usually appears normal, but it can be difficult to discern because herniated bowel loops may be pressed against it. Maternal serum alpha-fetoprotein concentrations usually are elevated and may be a marker for fetal gastroschisis, but specific diagnostic biochemical testing (eg, amniotic fluid acetylcholine esterase) is not recommended as a screening tool. Furthermore, genetic amniocentesis generally is not recommended because of the low risk of chromosomal abnormalities. Researchers have tried to identify sonographic predictors of bowel damage, such as fixed dilation of the herniated bowel and thickening of the bowel wall, but none has been …