Children's Hospital Colorado

Gastroschisis

Gastroschisis, which is Greek for "belly cleft," is an opening in a baby's abdominal wall. In addition to the small abdominal wall defect, there may be some of the baby's bowels (intestines) protruding through the opening.

For parents, the prospect of having a child with gastroschisis can, naturally, be very scary. But the good news is that most babies born with this defect achieve positive outcomes. At the Colorado Fetal Care Center, we work with families to diagnose gastroschisis early, as well as develop a treatment plan after birth.

Gastroschisis is a hole in the abdominal wall, which allows a baby's intestines to fall outside of the abdominal cavity. Gastroschisis is almost always located immediately to the right of the insertion of the umbilical cord, measuring about 2 to 3 cm in diameter. The hole can also be much larger, which may also cause the stomach, liver or other organs to be exposed.

What causes gastroschisis?

In most babies, the cause of gastroschisis is unknown. However, recent research has indicated that certain factors can increase the likelihood of having a baby with the condition. Those factors include young mothers (under 20 years of age) and smoking tobacco, drinking alcohol or using recreational drugs during pregnancy.

There are also reports that gastroschisis can occur again within the same family. Some research estimates that gastroschisis can recur in future pregnancies about 4 percent of the time.

Complications associated with gastroschisis

Gastroschisis, unlike other abdominal wall defects, is not associated with chromosomal abnormalities (chromosomes are the "blueprint" for the baby). In contrast to other anomalies, gastroschisis-associated abnormalities, if present, are confined to the GI tract.

Even when other abnormalities are present, they are not usually life-threatening. There is, however, an increased risk for intrauterine growth restriction (poor growth of the baby while in the uterus) and stillbirth in 10 percent of cases.

In addition to the obvious location of the organs outside of the body and potential damage to those organs due to exposure, infants with this condition can experience problems with feeding, digestion and absorption of nutrients.

Most cases of gastroschisis are diagnosed during routine ultrasounds. In addition, second trimester maternal serum alpha–fetoprotein (MSAFP) screening has shown a connection between elevated MSAFP levels and gastroschisis. The diagnosis of abdominal wall defects during the first trimester is difficult because it is normal for the bowel to protrude or push into the base of the umbilical cord. This is why the most reliable ultrasounds occur after 14 weeks of pregnancy, when the bowel should be entirely enclosed in the abdomen.

If gastroschisis is not diagnosed before birth, it will be evident upon delivery.

How will gastroschisis affect my pregnancy?

Obstetric complications associated with gastroschisis include intrauterine growth restriction (IUGR), a condition in which the baby does not grow appropriately while inside the uterus. This may affect up to 77 percent of fetuses with gastroschisis. Excess amniotic fluid (called polyhydramnios) or too little amniotic fluid (oligohydramnios) are also commonly seen with gastroschisis. There is also an increased risk for preterm labor due to the increased amount of amniotic fluid stretching the uterus more than usual.

There will be many more ultrasounds performed to assess the baby's growth as well as the amount of amniotic fluid surrounding him or her. In addition, fetal testing to check the baby's heart rate twice per week will begin between 30 to 32 weeks of pregnancy.

Often, delivery is recommended around 37 weeks of pregnancy (approximately 3 weeks early) to avoid the risk of stillbirth. It is generally recommended that you deliver in our state-of-the-art fetal center so we can better coordinate the obstetric, neonatal and pediatric surgical teams. There is no indication that a C-section is necessary in most cases, but you will discuss your delivery options with your team.

Gastroschisis is treated with surgery after birth, at which time the intestines are placed back in the baby's belly. There are no fetal interventions available at this time.

The extent of surgery required for your baby depends on how much of the intestines or additional organs lie outside of his or her body at birth and if there is an associated atresia or blockage in the intestine. Soon after the baby is born, surgeons place the organs inside of the abdominal cavity and close the opening in the abdominal wall. In more severe cases where the opening is large and multiple organs are exposed, surgeons may cover them and return them to the abdomen one by one over a period of time.

Babies with gastroschisis often need additional treatment during this process, including:

  • Intravenous nutritional supplementation
  • Antibiotics to prevent infection
  • Careful body temperature monitoring

Intravenous nutritional support is particularly important as it often takes days or even weeks for the GI tract to function well enough for feedings to fully support the baby.

Throughout treatment, our staff helps prepare families to care for their baby at home. We also connect loved ones with support groups and other resources to help them maintain their emotional and physical health.

What is the long-term outcome for babies with gastroschisis?

Surgical techniques to treat this condition have improved dramatically in recent years. Today’s modern procedures enable the vast majority of babies diagnosed with gastroschisis to live healthy lives. Their degree of need for ongoing care varies depending on the severity of their condition and associated symptoms.


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