Perinatal management of gastroschisis

Fetal anterior abdominal wall defects will be recognized with increasing frequency with the widespread use of maternal serum alpha-fetoprotein screening. A clear distinction must be made between omphalocele and gastroschisis, and counseling and obstetric management must be specific for each. Sixteen cases of gastroschisis were identified antepartum and followed through delivery between 1980-1986. There was one antepartum fetal death before institution of a protocol to deliver all such affected fetuses at 36 weeks. One patient was lost to follow-up. There were no antenatal or neonatal deaths among the 14 infants seen subsequently, all of whom were delivered by cesarean section. Only one infant had an additional nongastrointestinal defect (mild hearing loss), and all 14 were of appropriate weight for gestational age. Twelve infants had a single operative procedure for repair of the defect, with a mean hospital stay of 19.6 days. Scheduled cesarean delivery at 36 weeks, after confirmation of fetal lung maturity, presents the infant to the pediatric surgeon under controlled conditions and shortens neonatal hospital stay.