Gastroschisis: sonographic diagnosis, associations, management and outcome

Abstract

Gastroschisis is a defect in the abdominal wall, typically on the right side of a normally inserted umbilical cord through which bowel and other abdominal contents herniate. Classically, no membrane covers the herniated abdominal contents, which distinguishes the defect from exomphalos, an important differential diagnosis. Gastroschisis is usually diagnosed prenatally using ultrasound examination. The prevalence is increasing worldwide from approximately 0.1 per 10,000 total births in the 1970s to over 5 in the early 2000s. The reasons for this are unknown, but factors such as maternal smoking, recreational drugs and young maternal age are strongly associated with the defect. The increasing prevalence is causing concern because the cost of treating gastroschisis is high. Neonatal morbidity depends on significant complicating factors such as bowel atresia or necrosis and prolonged post-operative ileus. Foetuses with gastroschisis are more likely to be born premature and with intra-uterine growth restriction, both of which contribute to the morbidity. Gastroschisis requires early surgery after birth, often followed by prolonged neonatal care. However, advances in surgical and post-operative care in the last decade have meant that currently 90% of affected neonates survive, with few long-term problems.

Is Preterm Delivery Indicated in Fetuses with Gastroschisis and Antenatally Detected Bowel Dilation?

“…Published series report an increased rate of stillbirth associated with gastroschisis [21,22]. Controlling the risk for intrauterine fetal demise associated with gastroschisis has been a reported rationale in support of elective preterm delivery.…”

Congenital defects of abdominal wall

“…Осложнение беременности гастрошизисом у плода в большинстве наблюдений диагностируют до 20-й недели гестации. Ультразвуковое исследование проводят после того, как у беременной женщины определяется повышен-ный уровень альфа-фетопротеина [19,20]. Свободно пла-вающие в амниотической жидкости кишечные петли и дефект брюшной стенки, расположенный справа от пупо-вины, являются достоверными признаками заболевания.…”

Recent Advances in Neonatal Gastroenterology and Neonatal Nutrition

“…Development of polyhydromnios (Japaraj et al 2003) or of progressive bowel dilatation is considered by some to indicate a poor prognosis (David et al 2008, Payne et al 2009) and may warrant early delivery.…”