Gastroschisis – what should be told to parents?

Abstract

Gastroschisis is a common congenital abdominal wall defect. It is almost always diagnosed prenatally thanks to routine maternal serum screening and ultrasound screening programs. In the majority of cases, the condition is isolated (i.e. not associated with chromosomal or other anatomical anomalies). Prenatal diagnosis allows for planning the timing, mode and location of delivery. Controversies persist concerning the optimal antenatal monitoring strategy. Compelling evidence supports elective delivery at 37 weeks' gestation in a tertiary pediatric center. Cesarean section should be reserved for routine obstetrical indications. Prognosis of infants with gastroschisis is primarily determined by the degree of bowel injury, which is difficult to assess antenatally. Prenatal counseling usually addresses gastroschisis issues. However, parental concerns are mainly focused on long-term postnatal outcomes including gastrointestinal function and neurodevelopment. Although infants born with gastroschisis often endure a difficult neonatal course, they experience few long-term complications. This manuscript, which is structured around common parental questions and concerns, reviews the evidence pertaining to the antenatal, neonatal and long-term implications of a fetal gastroschisis diagnosis and is aimed at helping healthcare professionals counsel expecting parents.

Mode of delivery and outcomes of infants with gastroschisis: a meta-analysis of observational studies

“…Nevertheless, our results were consistent with their findings: mode of delivery was unrelated to NEC (pooled relative risk (RR) 1.27, 95% CI 0.35 to 4.58), duration until initiation of enteral feeding (pooled standardised RR −0.12, 95% CI −0.42 to 0.16) or length of hospital stay (pooled standardised RR −0.16, 95% CI −0.45 to 0.23). A more recent review by Lepigeon et al 30 also concluded that the available data did not support a requirement for CS delivery for infants with gastroschisis based on the following outcomes: bowel complications, primary closure, sepsis, length of hospital stay and mortality. Similarly, a review by Skarsgard et al 31 suggested that since there is no outcome benefit for routine CS delivery, then it is generally accepted that VD is the preferred mode of delivery.…”

Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis

“…Parental counseling 54 should take into account the presence of IABD and polyhydramnios and their association with BA. These signs are suspicious of BA, and the possibility of postnatal and postsurgical complications should be disclosed with parents during the prenatal period.…”

Predicting Perinatal Outcome from Prenatal Ultrasound Characteristics in Pregnancies Complicated by Gastroschisis

“…This staging of GS would provide families and medical professionals with crucial information about the postnatal outcome [17]. The objective of this study is to establish the accuracy of prenatal ultrasound markers at the second and the third trimester of pregnancy in the prediction of complex GS.…”