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  What is Gastroschisis?

Gastroschisis is the most common birth defect of the frontal abdominal wall, (~1 per 2500 pregnancies) and is usually detected by routine exams such as maternal serum and ultrasound screening. This defect results in the development of a baby’s intestines outside of the abdominal cavity during pregnancy. Prenatal care involves follow-up ultrasound imaging and an arranged delivery at a perinatal hospital. Treatment after birth is either early or delayed surgical closure of the birth defect site. After surgery, the infants are hospitalized in a neonatal intensive care unit (NICU) for several weeks. Infants usually require ventilator (breathing) support, nutritional support, antibiotics and other assistance. The post-operative survival rate of these infants is nearly 90%. The most problematic post-operative complication of Gastroschisis is intestinal injury and/or "failure". Intestinal injury is a result of damage which occurs in the uterus when the baby’s intestines come into contact with amniotic fluid as they develop.

There is some controversy surrounding the care of fetuses with prenatally diagnosed GS. Many physicians recommend a planned premature delivery, with the view that having less intestinal damage will outweigh the consequences of premature birth. However, others believe there is no advantage to early delivery. The best route of delivery (vaginal versus Cesarean section) is also controversial. Some pediatric surgeons and obstetricians support choosing planned cesarean delivery, because they believe that the conditions for surgery are best right after birth. In that case, surgical repair of gastroschisis occurs right after birth in the delivery room. However, other doctors recommend delaying the surgery and instead use a plastic bag (silo) to protect the intestines. Still others support the treatment method of using selective, primary awake repair using pain relief medication (where patient is conscious but feels no pain), rather than repair under general anesthesia (the patient is completely unconscious). This is because using general anesthesia usually results in a period of required mechanical ventilation. Consequently, it is clear that there is currently no agreement on what the "best" surgical care is for these patients.

 

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