Gastrochisis

What Is Gastroschisis?

Gastroschisis is a birth defect that develops in a baby while a woman is pregnant. This condition occurs when an opening forms in the baby’s abdominal wall. The baby’s bowel pushes through this hole. The bowel then develops outside of the baby’s body in the amniotic fluid.

The opening is most often on the right side of the baby’s belly button. It can be large or small, but is typically one to two inches in size. In more severe cases, the stomach and/or liver can sometimes make their way through the opening as well.

Because the bowel is outside of the baby’s body, it is unprotected. That means there is a chance it can become irritated, swollen and damaged.

This condition is relatively rare but has seen an increase in recent years. It occurs in about one in every 2,000 babies. It develops early in pregnancy, during the fourth through eighth weeks. Gastroschisis occurs due to a weakness in the baby’s abdominal wall muscles near the umbilical cord. If your baby develops this condition during your pregnancy, you will not experience any symptoms related to it.

Gastroschisis can be repaired with surgery after your baby is born. It is usually not associated with other malformations.

What Causes Gastroschisis?

The exact cause of gastroschisis is not known. It does not appear to be inherited. Having one baby with gastroschisis does not make it more likely that you would have another baby with the condition.

Severity of Gastroschisis

Gastroschisis is labeled as simple or complicated. This is based on how inflamed the bowel and/or organs are that have moved through the opening.

With simple gastroschisis

With complicated gastroschisis, one or more of the following occurs:

  • The bowel outside of the baby’s body is extremely damaged, e.g., a portion of the tissue has died (called necrosis), or the bowel has become twisted or tangled.
  • Intestinal atresia, which occurs when part of the baby’s bowel doesn’t form completely, or the intestine is blocked.
  • Other organs, such as the stomach or liver, protrude out of the opening as well.

Simple cases are more common than complicated ones.

Gastroschisis Evaluation and Diagnosis

It is possible for gastroschisis to be detected in the third month of pregnancy. However, we most often perform evaluations for it at 20-24 weeks, after it has shown up on an ultrasound. It is most commonly diagnosed by ultrasound around weeks 18-20 of pregnancy.

Some women are referred to us for gastroschisis late in pregnancy. We see them within two weeks of their referral. It is important to make a diagnosis and delivery plan as early as possible.

In babies with gastroschisis, the ultrasound will show loops of bowel floating freely. This often shows up when a woman goes in for a routine ultrasound with her obstetrician (OB). It is at this point that most of our patients affected by gastroschisis are referred to hospitals. Here, we’ll work with you to assess how severe your case is and create a plan for the remainder of your pregnancy. We will also talk to you about what to expect after delivery.

An evaluation for gastroschisis consists:

  • An ultrasound (we can use an ultrasound performed within two weeks of your appointment with us, or one will be done on the day of your evaluation)
  • Possibly an MRI and/or a fetal echocardiogram to test your baby’s heart function
  • A meeting with a nurse, social worker and genetic counselor
  • A team meeting with a maternal-fetal medicine specialist (MFM), pediatric surgeon and neonatologist

An important part of the evaluation is determining whether the condition is gastroschisis or omphalocele. These conditions can sometimes look similar on an ultrasound. In omphalocele, a sac from the umbilical cord covers and protects the intestines that are outside of the baby’s body.

After your tests are complete, our team of experts meets with you to discuss the extent of the baby’s condition and its impact on the rest of the pregnancy. We’ll also cover medical treatments that might be needed right after the birth of your child, and long-term prognosis of babies with gastroschisis.

For patients who are local or plan to deliver locally, we also discuss:

  • Delivery at one of our level III hospitals
  • Transferring your baby to Cincinnati Children’s
  • Postnatal surgical care for your baby
  • Length of stay in the neonatal intensive care unit (NICU)
  • Possible complications that could arise

We recommend frequent ultrasounds throughout the remainder of your pregnancy. These will help to monitor your baby’s health, the severity of the gastroschisis, and how it evolves.

Gastroschisis Treatment Options

There are no fetal interventions recommended for babies with gastroschisis. The condition cannot be corrected while you are pregnant. Rather, it must be treated right after your baby is born.

Any baby with gastroschisis must have surgery after birth. An infant cannot survive with his or her bowel outside of the body.

After your baby is born, doctors will assess how severe the gastroschisis is. The type of repair needed depends on how much bowel and/or organs are outside of your baby’s belly and any inflammation or damage to those tissues.

Primary Repair

With a simple gastroschisis, treatment often is what’s called a “primary repair.” This is a surgery where the bowel is placed back inside of the baby’s belly and the abdominal opening is closed. When possible, this surgery is done the day your baby is born.

This type of repair is performed when there’s relatively small amount of bowel outside of the belly, and the bowel is not overly swollen or damaged.

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