ABSTRACT
Gastroschisis is more often an isolated lesion with a right para-umbilical defect.64 There is no membrane covering the exposed bowel. On ultrasound, the bowel appears to be free-floating and the loops may appear to be thickened due to peel formation from exposure to amniotic fluid (Fig. 2.6). Dilated loops of bowel may be seen from obstruction secondary to protrusion from a small defect. Gastroschisis is sometimes complicated by intestinal atresias or obstruction, leading to polyhydramnios and preterm labor. The pathophysiology of bowel damage is due to amniotic fluid exposure and bowel constriction, the latter leading to ischemia and venous obstruction.65,66
Predicting outcome in fetuses with gastroschisis based on prenatal ultrasound findings remains a challenge. There is some evidence that maximum small bowel diameter may be predictive,67,68 consistent with the observation that patients who have a poorer outcome frequently have bowel atresias.68 Although bowel ischemia may be a contributing factor in the prenatal damage, Doppler velocimetry measurements of superior mesenteric artery are not predictive of outcome.69 The perinatal management and mode of delivery are also controversial: although there are conflicting views as to vaginal vs cesarian section delivery, a recent series failed to detect a difference in outcome based on mode of delivery, site of delivery, diagnostic methods, or prenatal Maternal Fetal Medicine (MFM) consult.70 Currently, we advocate serial ultrasound measurements to monitor for development of bowel obstruction and offer an immediate repair strategy after planned cesarian section.
