This information brochure has been developed by Mater's Centre for Maternal Fetal Medicine (MFM). It is not intended to take the place of comprehensive counselling and support, which is provided as part of our service, but it will provide some background information for you to consider.
What is Gastroschisis?
Gastroschisis is a gap in the abdominal wall usually to the right of the umbilical cord which allows the bowel to pass through (herniate) into the amniotic cavity. Small bowel and sometimes other abdominal organs such as the stomach or liver can also herniate through the abdominal wall defect and be exposed to amniotic fluid.
Why does gastroschisis occur?
It is not known why Gastroschisis occurs during fetal development. It is an abnormality that is more common in younger women for reasons that are not well understood. Gastroschisis is not considered to increase the chance of the baby having a chromosome abnormality.
How is gastroschisis diagnosed?
Gastroschisis is usually detected at the routine 18–20 week ultrasound scan when loops of bowel are seen protruding outside of the abdomen. It may be suspected at earlier gestations e.g. at the time of the nuchal translucency scan after 12 weeks gestation.
What are the complications with gastroschisis?
Babies with gastroschisis can have growth delay and this is why we recommend monitoring the baby's growth, by ultrasound, through the pregnancy.
To assess growth progress there has to be at least a two week interval between scans.
Sometimes the bowel inside or outside of the abdomen might become swollen or dilated and this might indicate a higher risk of bowel damage as a result of the gastroschisis. Earlier delivery of the baby before term has not shown to improve the outcome for bowel problems or survival in babies with gastroschisis. Preterm delivery can also make matters worse for the newborn due to problems resulting from prematurity such as breathing and feeding difficulties.
However, preterm delivery might be necessary if the baby's growth slows and there is concern about the baby's health in-utero. Ultrasound assessment of the amniotic fluid volume and blood flow in the umbilical cord and fetal heart rate by cardiotocograph (CTG) will assist in decisions regarding the timing and mode of birth.
Delivery decisions therefore are not made on the appearance of the fetal bowel as the baby's outcome is generally improved when prematurity can be avoided.
Ninety to ninety-five per cent of babies identified with gastroschisis survive the pregnancy which means that five to 10 per cent of babies with gastroschisis will not be born alive. If a baby with gastroschisis is born alive, up to 10 per cent (1 in 10) will have problems after birth including dead gut or short gut syndrome, infection or surgical complications which may result in the baby's death or ongoing problems.
How do you monitor babies with gastroschisis during pregnancy?
Review in Maternal Fetal Medicine (MFM) is recommended at 28, 32 and 34 weeks gestation with weekly review thereafter. Neonatal consultation is arranged at 28 weeks gestation and a tour of the Neonatal Critical Care Unit (NCCU) is also usually arranged at this time. Relocation to Brisbane is recommended from 35 weeks gestation or earlier if indicated. Cardiotocograph (CTG) monitoring is also recommended at the weekly visit from 34 weeks gestation. In cases where fetal growth problems or increased or decreased amniotic fluid is identified, more monitoring may be indicated and the care will be individualised accordingly.
Delivery at a tertiary hospital is recommended where neonatal intensive care and paediatric surgery is available. Antenatal care will be case-managed with the MFM case manager midwives, who will remain a central point of contact through the pregnancy. You will initially meet an MFM midwife at one of your early appointments to MFM and then at all subsequent appointments. The MFM midwives will assist you with your maternity booking at Mater Mothers' Hospital, accommodation needs, support and ongoing pregnancy care.
Ultrasound scans are performed by the MFM sonographers and the images are reviewed by doctors within the department. MFM specialist consultation will occur at the first visit and then only as required on subsequent visits.
What about the timing and mode of delivery?
Choosing the correct gestation to deliver babies with gastroschisis balances the risks of prematurity against the risks of pregnancy continuation. We aim to deliver at 37 weeks gestation unless fetal growth or wellbeing assessment suggests we should deliver earlier. The outcome of gastroschisis is not improved by caesarean section (CS) unless there are other indications for CS. In most cases women whose babies have gastroschisis can deliver naturally. Induction of labour is usually planned at 37 weeks gestation if spontaneous labour does not occur prior.
What happens after birth?
After birth, admission to the Neonatal Critical Care Nursery (NCCU) is indicated followed by review with a paediatric surgeon. The bowel may sometimes be manually reduced into the baby's abdomen in the NCCU or the baby may need to have a procedure performed in the operating theatre under general anaesthetic. A 'silo' may be used so that the bowel can be reduced gradually over time. In some cases, part of the baby's bowel will be surgically removed, which may result in a condition called 'short gut syndrome' or other bowel dysfunction. Longer term problems related to malabsorption and/or bowel obstruction can also occur. More information regarding baby's care whilst in the NCCU will be discussed at your consultation with the neonatologist.
Social work and pastoral care services
Mater's social work and pastoral care services are available to support our women and families. Please speak to one of the MFM midwives or your health care team if you and your family would like to talk to someone from these services.
For further information please contact the centre between 8.30 am and 4.30 pm, Monday to Friday by phoning 07 3163 1896. The MFM midwives can also be contacted through this number, or alternatively, you will be given their direct contact details at your first visit with them.
Alternatively you may contact the Centre by email at firstname.lastname@example.org
Centre for Maternal Fetal Medicine
Mater Mothers' Hospital
South Brisbane Qld 4101
Phone: 07 3163 1896
Fax: 07 3163 1890
Mater acknowledges consumer consultation in the development of this patient information.
Last modified 16/11/2015.