Gastroschisis

When the muscles and skin fail to form normally in the abdominal wall, this results in an abdominal wall defect. Gastroschisis is the most common of the abdominal wall defects. Babies born with gastroschisis have a hole in the abdominal wall.

What is Gastroschisis?

Normally, during prenatal developmental, the muscles and skin that form the abdominal wall completely close by the 12th week of pregnancy. When the muscles and skin fail to form normally, this results in an abdominal wall defect. Gastroschisis is the most common of the abdominal wall defects. Babies born with gastroschisis have a hole in the abdominal wall. The intestines, and sometimes other organs, come through a small opening to the right of the umbilical cord, and float freely in the amniotic fluid. Because the intestines have been exposed to the amniotic fluid, they may be swollen and covered with a thick film, which can make the intestines function poorly. About 10% of babies with gastroschisis will have another problem within the bowel, such as an interruption in the intestine (atresia, absence of a portion of the intestine), and, less commonly, a perforation, or rupture causing a hole in the intestine. Problems with organs other than the intestines are very uncommon in babies with gastroschisis. The survival rate for babies born with gastroschisis is 95%.

What Causes Gastroschisis?

The exact cause of gastroschisis is not known. Gastroschisis affects both males and females in equal numbers. Most babies with gastroschisis are born to young mothers in their first pregnancy. It is congenital, meaning it happens before your baby is born. Usually, the condition is not inherited, and future pregnancies are not affected. Usually there is not a family history of gastroschisis.

How Gastroschisis is Diagnosed?

Gastroschisis may be found during routine prenatal ultrasound. If your doctor suspects a problem, additional tests may be ordered. These may include:

  • Fetal echocardiogram: A fetal echocardiogram is a special ultrasound used by a pediatric heart doctor (cardiologist) to look closely at your baby’s heart and surrounding blood vessels.
  • Fetal MRI (magnetic resonance imaging): This type of imaging gives more detailed pictures of your baby’s organs.

These tests are not typically needed unless your doctor suspects there may be other problems with your baby.

Other Tests

Some congenital conditions are a result of changes in DNA, or a baby’s genetic make-up. The doctors may suggest genetic testing to find out more about your baby’s DNA.

  • Cell-Free Fetal DNA testing: Your doctor can take a sample of your blood to look for copies of fetal (baby) DNA. This is only a screening test. A positive result means that there could be problems with the DNA. This should be confirmed with another test to be sure of the result. This additional testing can be done before or after birth depending on your needs and the needs of the baby.
  • Amniocentesis: A small sample of the amniotic fluid that surrounds the baby in the womb is taken and tested for DNA problems. This test is usually done in the middle of the second trimester. An amniocentesis can be used to confirm findings on the cell-free fetal DNA test.
  • Testing the baby: After birth, a test is done with a sample of your baby’s blood to look for chromosome problems. This is called either a “karyotype” (basic chromosome study), or microarray (a more detailed look at smaller pieces of DNA).

Genetic changes are very uncommon in babies with gastroschisis.

How is Gastroschisis Treated During Pregnancy?

If a test finds you are carrying a baby with gastroschisis, you will continue to receive care from your obstetrician. Your obstetrician may refer you to the Fetal Center at Nationwide Children’s to connect you with a team of fetal medicine experts.

There, you will meet with a multidisciplinary team including neonatologists (doctors who specialize in treating newborns), pediatric surgeons (doctors who perform surgery), and nurses to learn more about your baby’s care after he or she is born. Nurse coordinators will help answer your questions and concerns, guide you through your pregnancy, and prepare you for what to expect. 

Your doctor will watch your pregnancy closely. There is a risk of preterm delivery when a baby has gastroschisis. You should deliver your baby at a hospital that is ready to care for high-risk babies like yours. You should discuss your plans for labor and delivery with your obstetrician. Contact your doctor right away if you have any concerns.

How is Gastroschisis Treated After Your Baby is Born?

At the delivery hospital, a neonatologist (a doctor who specializes in treating newborns) will manage the care of your baby. The neonatologist will assess your baby’s breathing and heart rate, and examine the baby for other problems.

  • Your baby will briefly receive care in your delivery hospital’s neonatal intensive care unit (NICU).
  • As soon as your baby is born, a sterile plastic bag called a bowel bag will be placed over the baby’s feet and pulled up over the bowel to the chest, to help protect the intestines. This bag helps to prevent infection by keeping germs from getting to the intestines, and helps keep your baby warm and hydrated. This bag stays on until he or she is evaluated by the surgeons at the hospital.
  • A tube will be put through your baby’s nose (nasogastric, NG) or mouth (orogastric, OG) down into the stomach. This tube helps to keep the stomach and intestines empty and decompressed.
  • An intravenous line (IV) will be started in your baby’s arm, hand, foot or scalp. The IV provides fluids and antibiotics to prevent dehydration and infection.
  • Your baby may need extra oxygen to help ensure there is good blood flow to the intestines.
  • Your baby will be immediately transferred to the Children’s Hospital neonatal intensive care unit (NICU) for further care.