VI. GASTROSCHISIS
Gastroshisis is congenital defect of the anterior abdominal wall characterized by
herniation of a variable amount of uncovered intestine. The liver is normally positioned.
The defect is usually on to the right of the umbilical cord. It is thought that this may be
due to the natural disappearance of the right umbilical vein during the course of fetal
development.
Incidence of gastroschisis is about 1 in 3,000-8,000 live births. Associated
anomalies are rare except for intestinal atresia (10-15%) of cases
Risk factors include maternal use of tobacco, salicylates, pseudoephedrine, or
phenylpropanolamines during the first trimester. Maternal young age is also a risk
factor.
Gastroschisis is NOT a contraindication to vaginal delivery.
Management in the Delivery Room
In the delivery room, an airway if infant in respiratory distress. The intestines
should be handled gently making sure that the mesentery is straight. The bowel is
placed on top of abdomen without tension to avoid impediment to venous drainage and
to avoid inducing bowel edema and injury. Consider putting the baby on the side. The
baby should be have his legs placed in a plastic bag (bowel bag) or if this is not