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Gastroschisis: A Review of Management and Outcomes

O'Connell, Rachel V. BS; Dotters-Katz, Sarah K. MD; Kuller, Jeffrey A. MD; Strauss, Robert A. MD

Obstetrical & Gynecological Survey: September 2016 - Volume 71 - Issue 9 - p 537–544
doi: 10.1097/OGX.0000000000000344
CME ARTICLES
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CME

We performed an evidence-based review of the obstetrical management of gastroschisis. Gastroschisis is an abdominal wall defect, which has increased in frequency in recent decades. There is variation of prevalence by ethnicity and several known maternal risk factors. Herniated intestinal loops lacking a covering membrane can be identified with prenatal ultrasonography, and maternal serum α-fetoprotein level is commonly elevated. Because of the increased risk for growth restriction, amniotic fluid abnormalities, and fetal demise, antenatal testing is generally recommended. While many studies have aimed to identify antenatal predictors of neonatal outcome, accurate prognosis remains challenging. Delivery by 37 weeks appears reasonable, with cesarean delivery reserved for obstetric indications. Postnatal surgical management includes primary surgical closure, staged reduction with silo, or sutureless umbilical closure. Overall prognosis is good with low long-term morbidity in the majority of cases, but approximately 15% of cases are very complex with complicated hospital course, extensive intestinal loss, and early childhood death.

Target Audience Obstetricians, Maternal Fetal Medicine Providers, Certified Nurse Midwives, and Family Medicine Providers.

Learning Objectives After participating in this activity, the reader should be able to describe common pregnancy complications associated with gastroschisis; discuss options for prenatal and antenatal fetal surveillance; counsel parents regarding prenatal predictors of neonatal outcome and long-term prognosis; and describe the evidence-based recommendations for timing and mode of delivery.

*Medical Student, UNC School of Medicine, Chapel Hill, NC; †Clinical Fellow, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, NC; and §Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Sarah K. Dotters-Katz, MD, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill, NC 27599-7516. E-mail: sarah.dotters-katz@duke.edu.

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