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GastroschisisTreatments

• What are my choices during this pregnancy?
• What will happen after birth?

What are my choices during this pregnancy?

It is important to It is important to carefully monitor throughout your pregnancy. Additional tests, other than ultrasounds, are not usually recommended, as this is a condition that is not associated with any other birth defect. Rarely, babies can also have bowel obstruction (blockage) as a consequence of the gastroschisis.

Babies with gastroschisis are watched carefully by ultrasound for intrauterine growth retardation (not growing enough while in the womb) and for damage to the intestines. Damage to the intestine can be caused from exposure to the amniotic fluid or by impairment of the blood flow to the exposed intestine.

Since most fetuses with gastroschisis will do well with serial sonographic observation and preparation for delivery near term at an appropriate tertiary center, the most important decisions have to do with where the baby will deliver and what team of doctors will look after the baby before and after birth. Your perinatologist (specialized obstetrician) will discuss your delivery plans. It is not necessary to deliver your baby by Cesarean section. Delivering your baby vaginally will not be harmful to you or your baby.

The most important consideration is to be born at the center where the intestines can be immediately covered and kept warm and moist until surgical repair or silo placement. The biggest threat to the baby and to the condition of the intestine is to have to transport the baby to another medical center or in any way delay the repair. Therefore, delivery plans should be coordinated with your neonatologist (specialized pediatrician for newborns) and pediatric surgeon.

Fetal Treatment

When fetuses with progressive bowel damage are identified, there are several potential treatments. If the bowel damage is caused by exposure to amniotic fluid itself or inflammatory components in amniotic fluid, the amniotic fluid itself can be cleansed by serial aminoexchange. The idea of serial amniocentesis or replacing amniotic fluid with clean fluid, is currently being tested.

It is unclear whether serial amniocentesis or replacing amniotic fluid is effective and, if so, at what intervals and what volumes of amniotic fluid should be exchanged. If the bowel is damaged by being squeezed at its base by the smallness of the hole in the fetus’s abdominal wall, it would be possible to enlarge this with a fetoscopic procedure (FETENDO fetal surgery). At present, the best known treatment is to follow carefully for evidence of damage to the bowel and adjust the timing of delivery accordingly.

What will happen after birth?

Your baby should be born at a hospital with an Intensive Care Nursery and a pediatric surgeon available. Soon after birth, your child will have surgery to close the opening in the abdominal wall and return the organs to the abdomen. The pediatric surgeon attempts to close the opening at the time of surgery, but sometimes this is not possible.

If the gastroschisis is too large, a silo is placed.   A silo is a covering placed over the abdominal organs on the outside of the baby. Gradually, the organs are squeezed by hand through the silo into the opening and returned to the body. This method can take up to a week. Babies with gastroschisis can stay in the hospital from 2 weeks to 3-4 months. Because your baby's intestine has been floating in amniotic fluid for months, it is swollen and does not function well. The return of the function of the gastrointestinal tract and the baby's ability to tolerate feedings are two factors which determine the length of stay in the hospital. Babies are discharged from the hospital when they are taking all their feedings by mouth and gaining weight.

After discharge from the hospital, your baby has a small risk for developing bowel obstruction due to scar tissue or a kink in a loop of bowel. Symptoms of bowel obstruction include: 1) bilious (green) vomiting, 2) a bloated stomach, and 3) no interest in feeding. If any of these symptoms occur, you should contact your pediatrician immediatealy.