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Fetal Gastroschisis

Gastroschisis_s.gifFetal gastroschisis is a congenital defect in a baby's abdominal wall that allows the infant's intestines to protrude through to the outside. This opening in the abdominal wall is usually small and located to the right of the umbilical cord's insertion point. While the infant is in the womb, the intestines float free in the amniotic fluid (bag of waters), which irritates them and causes the intestines to cease their normal movement both before and after birth. With time, normal movement returns after birth, but it often takes several weeks.

Babies born with gastroschisis are generally otherwise healthy. A small percentage of babies with the condition also have blockages called “atresias” of the bowel — a problem that can occur without gastroschisis and which requires surgery to correct.

Pregnancies with gastroschisis often go into labor early, and they are allowed to deliver vaginally unless there is another obstetrical reason to have a C-section.

Approximately one in every 5,000 births is affected by gastroschisis, and for some reason it seems to affect children of younger mothers. It is highly unusual for a mother to have a second child with the condition.

Fetal gastroschisis is treated by our specialists in the Institute for Fetal Health.

Diagnosis

Fetal gastroschisis is diagnosed by ultrasound (sonogram) examination prior to birth. Evaluation of the bowels is part of the routine ultrasound examination done by many obstetricians as part of their routine prenatal care around the 20th week of pregnancy.

Treatment

After fetal gastroschisis is diagnosed, the staff at Ann & Robert H. Lurie Children’s Hospital of Chicago counsels the parents and prepares them for what to expect when their baby is born. Plans are made to assure that the baby is delivered in a hospital that has a neonatal intensive care unit (NICU) and a neonatologist present at the delivery.

After birth, the baby is stabilized and then transferred via ambulance to Lurie Children's to begin treatment. First the intestines are suspended in a plastic tube (called a “silo”) above the baby's abdomen that protects them and allows gravity to gently replace them into the baby's belly. Once the intestines are back in the abdomen — a process that typically takes one to four days — the defect in the abdomen is closed with a stitch or two. While at this point the baby is repaired and "back together," the bowels usually don't start functioning for 3–6 (or more) weeks — the result of exposure to amniotic fluid while in the womb as described above. Consequently, the infant must remain in the hospital for feeding with intravenous solutions. After the intestines begin to function normally, the baby can begin to eat by mouth and go home.

Long-term Effects

The long-term outlook for these children is very good. Of the infants diagnosed before birth, approximately 95% of them are expected to survive and have a normal life expectancy.