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Gastroschisis: A Review of Management and Outcomes

Rachel V O'Connell1, Sarah K Dotters-Katz2, Jeffrey A Kuller3

  • 1Medical Student, UNC School of Medicine, Chapel Hill, NC.

Obstetrical & Gynecological Survey
|September 20, 2016
PubMed

Insights

This review covers gastroschisis (an abdominal wall defect) management. While most cases have good outcomes, about 15% are complex, requiring specialized care for survival.

Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Surgery
  • Fetal Medicine

Background:

  • Gastroschisis, an abdominal wall defect, is increasing in frequency.
  • Prenatal diagnosis is possible via ultrasonography and elevated maternal serum alpha-fetoprotein.
  • Risk factors include ethnicity and maternal health, with increased risks for fetal growth restriction and demise.

Purpose of the Study:

  • To review the evidence-based obstetrical management of gastroschisis.
  • To identify antenatal predictors of neonatal outcomes.
  • To outline current postnatal surgical strategies.

Main Methods:

  • Evidence-based literature review.
  • Analysis of studies on antenatal predictors.
  • Review of surgical management techniques.

Main Results:

  • Accurate prenatal prognosis remains challenging.
  • Antenatal testing is recommended due to risks of growth restriction, amniotic fluid abnormalities, and fetal demise.
  • Delivery by 37 weeks is generally advised, with cesarean delivery reserved for obstetric indications.

Conclusions:

  • The majority of gastroschisis cases have a good prognosis with low long-term morbidity.
  • Approximately 15% of cases are complex, involving complicated hospital courses and potential early childhood death.
  • Postnatal management includes primary closure, staged reduction with silo, or sutureless umbilical closure.

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