Long Medical Post

Gastroschisis
Current advances in surgical techniques and intensive care management for neonates have increased the survival rate to 90%, in adequate settings. The possibility of prenatal diagnosis either through echosonogram or any other method available allows the mother to be referred to an adequate center where a caesarean section or induced natural birth can be performed before term (as natural birth is recommended and just as safe as with a normal baby), preferably within 2 weeks of term, and allow the immediate surgery to be performed in the newborn. The general procedure for gastroschisis is to simply tuck the protruding organs back into the opening and apply a belly band pressure until the wound heals itself.

The morbidity is closely related to the presence of other malformations and complications of the wound or the intestine. Patients frequently require more than one surgery. It occurs in approximately 1 out of every 5,000 births. Approximately 20 to 40 percent will have some type of gastrointestinal abnormality such as: malrotation (bowel is not in correct position), atresia (passage is blocked), volvulus (twisting of the bowel, blood supply can be cut off), or infarction (blood supply has been cut off and that area will be damaged). Babies with gastroschisis are at an increased risk for stillbirth. The incidence of stillbirth is approximately 10 percent. These babies will often be smaller than normally expected. It is estimated that as many as 75 percent will be classified as growth restricted. This means the baby weighs less than we would expect for the gestational age.

Fetal movement counting will begin at approximately 26 weeks of gestation. You will be instructed to count your baby's movements once a day, every day, for a maximum of two hours. Your baby should move a minimum of 10 times in that two hours. If the baby moves ten times in 10 minutes you are done for that day. However if later in the day you notice your baby is not moving as much, you can always repeat the test. It is good to pick the same time each day and to do the test after eating. We often recommend a good time to do fetal movement counting is after a meal. If your baby fails this test call your doctor immediately or go directly to labor and delivery. A fetus with gastroschisis is at an increased risk for stillbirth (approximately 10 percent). Twice weekly nonstress tests will begin at around 32 weeks' gestation. Weekly biophysical profiles will begin at the same time. A biophysical profile combines the results of the nonstress test with an ultrasound. Delivery is scheduled between 35 to 37 weeks' gestation because of the increased risk for stillbirth. Labor is usually induced.

Omphalocele
An omphalocele is a birth defect in which the infant's intestine or other abdominal organs stick out of the belly button (navel). In babies with an omphalocele, the intestines are covered only by a thin layer of tissue and can be easily seen. Approximately 25 - 40% of infants with an omphalocele have other birth defects. They may include genetic problems (chromosomal abnormalities), congenital diaphragmatic hernia, and heart defects. Omphaloceles vary in size from very small to "giant". Small omphalocele's occur in 1 out of every 5,000 to 6,000 births. Large or "giant" omphaloceles occur in 1 out of every 10,000 live births. Many babies born with an omphalocele also have other abnormalities.

The chance for reoccurrence depends upon the underlying disorder:
Thirty percent have a chromosomal (genetic) abnormality, most commonly Trisomy 13, Trisomy 18, Trisomy 21, Turner syndrome, or triploidy. Some infants with omphalocele have a syndrome known as Beckwith-Wiedemann syndrome. More than half of babies with omphalocele have abnormalities of other organs or body parts, most commonly the spine, digestive system, heart, urinary system, and limbs.

How often does an omphalocele occur?
A "small" type omphalocele (involving protrusion of a small portion of the intestine only) occurs in one out of every 5,000 live births. A "large" type omphalocele (involving protrusion of the intestines, liver, and other organs) occurs in one out of every 10,000 live births.
More boys than girls are affected with omphalocele.