Gastroschisis - what should be told to parents?

• Published in: Prenatal diagnosis 2014-04, Vol.34 (4), p.316-326
• Main Authors: Lepigeon, Karine, Van Mieghem, Tim, Vasseur Maurer, Sabine, Giannoni, Eric, Baud, David
• Format: Article
• Language: English
• Subjects: Delivery, Obstetric - methods; Female; Gastroschisis - diagnosis; Gastroschisis - therapy; Humans; Parents - education; Patient Education as Topic; Pregnancy; Prognosis; Tertiary Care Centers; Treatment Outcome; Ultrasonography, Prenatal
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.4305

ABSTRACT Gastroschisis is a common congenital abdominal wall defect. It is almost always diagnosed prenatally thanks to routine maternal serum screening and ultrasound screening programs. In the majority of cases, the condition is isolated (i.e. not associated with chromosomal or other anatomical anomalies). Prenatal diagnosis allows for planning the timing, mode and location of delivery. Controversies persist concerning the optimal antenatal monitoring strategy. Compelling evidence supports elective delivery at 37 weeks' gestation in a tertiary pediatric center. Cesarean section should be reserved for routine obstetrical indications. Prognosis of infants with gastroschisis is primarily determined by the degree of bowel injury, which is difficult to assess antenatally. Prenatal counseling usually addresses gastroschisis issues. However, parental concerns are mainly focused on long‐term postnatal outcomes including gastrointestinal function and neurodevelopment. Although infants born with gastroschisis often endure a difficult neonatal course, they experience few long‐term complications. This manuscript, which is structured around common parental questions and concerns, reviews the evidence pertaining to the antenatal, neonatal and long‐term implications of a fetal gastroschisis diagnosis and is aimed at helping healthcare professionals counsel expecting parents. © 2013 John Wiley & Sons, Ltd. What's already known about this topic? Gastroschisis is a common anterior abdominal wall defect that is diagnosed antenatally in >90% of cases. What does this study add? In this manuscript, we reviewed antenatal, neonatal and long‐term implications of a diagnosis of fetal gastroschisis, with special attention to parental concerns and questions, in order to make it applicable for clinical practice. As survival of infants with gastroschisis has improved, our research focus should now move toward improving long‐term outcomes.