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Gastroschisis--what should be told to parents?
Karine Lepigeon1, Tim Van Mieghem, Sabine Vasseur Maurer
1Materno-fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, 1011, Lausanne, Switzerland.
Insights
Gastroschisis, a common birth defect, is typically diagnosed before birth. While newborns may face challenges, most infants with gastroschisis experience good long-term outcomes with proper care.
Area of Science:
- Pediatric Surgery
- Maternal-Fetal Medicine
- Neonatology
Background:
- Gastroschisis is a frequent congenital anomaly involving the abdominal wall.
- Prenatal diagnosis is highly effective through maternal screening and ultrasounds.
- Most cases are isolated, without other significant anomalies.
Purpose of the Study:
- To review evidence on antenatal, neonatal, and long-term outcomes of gastroschisis.
- To address common parental concerns regarding fetal diagnosis.
- To guide healthcare professionals in counseling expectant parents.
Main Methods:
- Literature review focusing on evidence-based practices.
- Structured around common parental questions and concerns.
- Analysis of antenatal monitoring, delivery strategies, and long-term prognosis.
Main Results:
- Prenatal diagnosis allows for delivery planning.
- Elective delivery at 37 weeks in a specialized center is recommended.
- Bowel injury is a key prognostic factor, though difficult to assess prenatally.
Conclusions:
- Infants with gastroschisis often have a challenging neonatal period.
- Long-term complications are infrequent despite initial difficulties.
- Effective prenatal counseling is crucial for managing parental expectations.
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.
