Gastroschisis can be diagnosed with moderate accuracy from the 14th week of gestation (3 months). While it's possible to intervene during pregnancy for a number of anomalies (see, for example, twin-to-twin transfusion syndrome), extensive research has shown that patients with gastroschisis (and omphalocele) are best treated after they are born, and that most in utero interventions would be too risky for the mother and child.
However, with advance knowledge of an abdominal wall defect, it is possible to change the plans for delivery of the baby:
Mode of delivery
Vaginal delivery does not put the baby at an increased risk of complications. For that reason, physicians now recommend a vaginal delivery, even for gastroschisis, unless there are obstetrical reasons to proceed with a Cesarean section.
Place of delivery
As long as he or she is inside the womb, the fetus with a gastroschisis is relatively well shielded from trauma and complications. After birth, however, the exposed intestines have to be protected from direct trauma, dehydration and infection. It is recommended that delivers take place in an institution that specializes in such births, such as Hasbro Children's Hospital.
Time of delivery
One of the concerns with gastroschisis is that the exposed bowel becomes so damaged that function is impaired and the baby may end up staying in the intensive care unit for a long time. Many infants with gastroschisis have what appears to be a damaged bowel, with very thick, rigid loops of intestines containing a "peel." One of the theories for the cause of this peel (and for the fact that some babies have little or no peel at all) is that prolonged exposure of the bowel to the amniotic fluid causes progressive damage. In other words, limiting the amount of time that the bowel is floating in this fluid (or even diluting that fluid by infusing sterile saline water inside the womb) could theoretically decrease the amount of peel and intestinal damage.
In our studies, we have not found any benefits of early deliveries, and so we recommend that babies be born as close to term as possible.
The Fetal Treatment Program is a partnership of Hasbro Children's Hospital, Women & Infants' Hospital and The Warren Alpert Medical School of Brown University.