My baby has gastroschisis on ultrasound scan

Introduction

This leaflet is aimed at pregnant women with suspected finding of a gastroschisis on ultrasound examination. The leaflet should only be given in consultation with a senior obstetrician or fetal medicine specialist.

Gastroschisis occurs when the baby’s abdominal wall does not fully develop, leaving a small hole close to umbilical cord insertion (belly button). This allows some of the baby’s bowel to protrude out into the amniotic cavity. The baby will need an operation soon after the birth to return the bowel back into the abdomen and repair the hole in the abdominal wall. It is not fully understood why this happens however it is more common in younger mums and mums who smoke.

Gastroschisis is rare, affecting approximately 1 in 3000 babies. Approximately 20 babies with gastroschisis are seen with this condition every year at the Royal Victoria Infirmary, Newcastle upon Tyne. This condition is not usually associated with other problems and a careful ultrasound assessment of your baby will be performed to confirm that this is the case.

Is gastroschisis a serious condition?

The outcome for most babies with gastroschisis is excellent. The most recent figures for babies born at the RVI show that 95% of babies with this condition survive. You will have antenatal care to monitor you and your baby to ensure that your baby is born in the best condition possible.

It is common for babies with gastroschisis to be delivered a few weeks before their due date and to be smaller than an average baby.

There are some additional possible serious complications that the baby may encounter:

1. The blood supply of the bowel may be restricted caused by twisting of the free floating bowel in the amniotic fluid. In some occasions the blood supply will be entirely cut off meaning a portion of bowel dies and will not function.
2. Narrowings or obstructions of portions of the bowel. It is known that approximately 10% of babies with gastroschisis will have additional narrowings in the bowel that are not easily visible on antenatal ultrasound, these will need further surgical repair after the baby is born.
3. A small number of babies with gastroschisis will develop longer term problems with feeding and absorbing food.

What will happen during the pregnancy?

You will continue your pregnancy under the care of a consultant and be offered regular ultrasound scans to assess growth, monitor the development of the bowel and measure the blood flow between your baby and the placenta. These scans will take place at your local hospital or at the RVI. During your third trimester one of these scans will be arranged at the Fetal Medicine department in a specialist surgical clinic. This review will allow you the opportunity to talk to one of the paediatric surgeons who will be responsible for the care of your baby after birth. If you would like a tour of the Special Care Baby Unit and Paediatric Intensive Care, where your baby will go after they are born, please ask the midwife caring for you in Fetal Medicine.

The best time for delivery will be discussed with you and a date for delivery will be arranged usually at around 37 weeks gestation. Planning the delivery at this gestation offers several benefits, particularly that the baby will be born at the RVI and close to the surgical team. Should labour start before your planned delivery date it is important to attend your closest hospital as soon as possible. Many hospitals can care for a baby with gastroschisis initially but soon after delivery the baby will need to be transferred to the RVI for specialist care. Planning a delivery date also helps to ensure that no more than one baby with gastroschisis is delivered on the same day.

How should I give birth to my baby?

The baby’s bowel will not be damaged by a vaginal delivery. Unless you need a caesarean section for another reason we always recommend aiming for a normal vaginal delivery. Your individual delivery options will be discussed further but please raise any questions or concerns you may have.

What will happen immediately after birth?

A neonatal team will be present in the delivery room to make an immediate assessment of your baby. A clear plastic bag will be placed over the lower half of your baby to keep the bowel moist and protected. After you have seen your baby, he or she will be transferred to the care of the paediatricians on Ward 35 (Special Care Baby Unit) next to the Delivery Suite. Babies usually spend only a short time on Ward 35 before being transferred to the care of the paediatric surgeons on Ward 12 at the RVI. At each stage we will do our best to ensure that you see your baby and are kept updated about their progress.

How is the gastroschisis repaired?

There are two possible techniques for closure of the hole, either a primary repair or a delayed closure. The condition of the bowel determines the surgical technique used.

A primary repair involves tucking the bowel back through the hole in the abdomen and then stitching the muscle layers together, sometimes aided by a synthetic patch to close the gap.

If a primary repair is not possible then the bowel is first protected by a silicone sheet to cover and protect it. This may allow a delayed primary repair or closure once gravity has gradually encouraged the bowel back into the abdomen. Once the bowel is in place the hole is closed as for primary repair.

How long will my baby stay in hospital?

As your baby’s bowel has been floating in amniotic fluid for some time it will have become inflamed and it will not function well. The length of stay will depend on how long it takes to get the bowel to work normally, with your baby feeding normally and gaining weight. This usually takes six-eight weeks. Your baby will be followed up with the paediatric team in the out-patient clinic.

Feeding your baby

Breast feeding is recommended as breast milk is easier for your baby’s bowel to digest. Where possible your own breast milk is stored and given to your baby when normal feeding starts. Until then we give your baby all the food needed through a drip.

For further information

For further information please contact:

Fetal Medicine Department,
Royal Victoria Infirmary
(0191) 2825837
Monday –Friday 9-5pm

Be sure to ask questions to the doctor supplying you with this leaflet and make a note of any questions you would like to ask at your next Fetal Medicine Unit appointment.

Antenatal Results and Choices
0845 077 2290 or 0207 713 7486 via mobile

North of Tyne Patient Advice and Liaison Service (PALS)
0800 0320202
Monday to Friday 9.00-4.30pm (answer phone out of hours)
Email: northoftynepals@nhct.nhs.uk