Development of a prenatal clinical care pathway for uncomplicated gastroschisis and literature review

Author:

Chabra Shilpi1,Peterson Suzanne E.2,Cheng Edith Y.3

Affiliation:

1. Department of Pediatrics, Division of Neonatology, Seattle Children’s Hospital and University of Washington, Seattle, WA, USA

2. Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine Swedish Medical Center, Seattle, WA, USA

3. Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine, Seattle Children’s Hospital and University of Washington Medical Center, Seattle, WA, USA

Abstract

BACKGROUND: Gastroschisis is an abdominal wall defect wherein the bowel is herniated into the amniotic fluid. Controversy exists regarding optimal prenatal surveillance strategies that predict fetal well-being and help guide timing of delivery. Our objective was to develop a clinical care pathway for prenatal management of uncomplicated gastroschisis at our institution. METHODS: We performed a review of literature from January 1996 to May 2017 to evaluate prenatal ultrasound (US) markers and surveillance strategies that help determine timing of delivery and optimize outcomes in fetal gastroschisis. RESULTS: A total 63 relevant articles were identified. We found that among the US markers, intraabdominal bowel dilatation, polyhydramnios, and gastric dilatation are potentially associated with postnatal complications. Prenatal surveillance strategy with monthly US starting at 28weeks of gestational age (wGA) and twice weekly non-stress testing beginning at 32wGA is recommended to optimize fetal wellbeing. Timing of delivery should be based on obstetric indications and elective preterm delivery prior to 37wGA is not indicated. CONCLUSIONS: Close prenatal surveillance of fetal gastroschisis is necessary due to the high risk for adverse outcomes including intrauterine fetal demise in the third trimester. Decisions regarding the timing of delivery should take into consideration the additional prematurity-associated morbidity.

Publisher

IOS Press

Subject

Pediatrics, Perinatology and Child Health

Reference71 articles.

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2. Increasing prevalence of gastroschisis: Population-based study in California;Vu;J Pediatr,2008

3. Rising prevalence of gastroschisis in Washington State;Chabra;J Toxicol Environ Health A,2011

4. Gastroschisis: A plea for risk categorization;Molik;J Pediatr Surg,2001

5. Hospital stays, hospital charges, and in-hospital deaths among infants with selected birth defect – United States, 2003;Centers for Disease Control and Prevention;MMWR,2007

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