Gastroschisis Flashcards
What is gastroschisis?
Full thickness (skin, muscle, fascia) abdominal wall defect that is to the right of the umbilical cord insertion with abdominal viscera protruding through the defect (bowel and liver)
What are the risk factors for gastroschisis?
Young maternal age, smoking, use of vasoactive drugs and low socioeconomic status
How does gastroschisis occur?
Abnormal involution or vascular damage to the omphalomesentary artery or right umbilical vein
Describe the ultrasound characteristics of a gastroschisis?
Multiple loops of bowel floating freely in the amniotic fluid (cauliflower appearance)
How do you counsel a patient if gastroschisis is identified on ultrasound?
85% occur in isolation. Non-GI association - arthrogryposis
What additional work up do you perform if gastroschisis is identified on ultrasound?
Detailed anatomic survey Serial growth ultrasound Fetal echocardiogram Antenatal testing at 32 weeks Pediatric surgery consultation Antenatal NICU consultation
What is the likelihood of the associated anomalies if gastroschisis is identified on ultrasound?
15%.
Remember that 85% are isolated
What is the likelihood of the underlying genetic abnormality if gastroschisis is identified on ultrasound?
Not typically associated with aneuploidy
What is your differential diagnosis for an elevated maternal serum alpha fetoprotein?
Wrong gestational age Twin pregnancy Gastroschisis Ruptured omphalocele Open neural tube defect Liver necrosis Placental abnormality Congenital skin defects Cystic hygroma Decreased maternal weight Teratoma Oligohydramnios
How do you follow a pregnancy complicated by gastroschisis?
Detailed anatomic survey Serial growth ultrasound Fetal echocardiogram Antenatal testing at 32 weeks Pediatric surgery consultation Antenatal NICU consultation
What pregnancy complications may occur if fetal gastroschisis is identified?
IUFD
FGR
Bowel atresia (infarction /ischemia) - more likely with bowel dilation which is defined as size >7mm however 29% occur with size >14mm
Short gut syndrome (motility disorders)
When do you recommend fetuses with gastroschisis to be delivered?
37 weeks. vaginal delivery
What is the recurrence rate of fetal gastroschisis?
4%
