Fig. 1
Newborn infant with gastroschisis. The gastroschisis defect in the abdominal wall occurs to the right of the umbilicus and there is no sac covering the viscera (Source: Centers for Disease Control and Prevention, Atlanta, GA. http://www.cdc.gov/ncbddd/birthdefects/Gastroschisis-graphic.html. Downloaded 17 Dec 2013)
(a)
Embryology of gastroschisis is controversial. The defect may represent a ruptured omphalocele or could be the result of involution of a second umbilical vein.
(b)
Epidemiology: associated with young maternal age and intestinal atresia
2.
Diagnosis: usually by fetal sonography after 20 weeks gestation.
3.
Treatment:
(a)
Vaginal birth is still possible.
(b)
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Stabilize the newborn:
(i)
Examine bowel for perfusion and perforation. Protect exposed bowel and prevent heat and fluid loses; this is usually accomplished by placing a bowel bag up to axillae. Later placement of silastic silo may be needed. The bowel is typically inflamed and matted due to exposure to amniotic fluid.
(ii)
NPO and NGT for gastric decompression and associated ileus.
(iii)
IVF resuscitation: may require two to three times usual maintenance due to excessive fluid losses from exposed bowel.
(iv)
Broad-spectrum antibiotic coverage.
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