In gastroschisis, the muscles of the abdominal wall do not close correctly while the fetus is developing. Part of the stomach or intestines protrudes outside the fetus's body, floating in the amniotic fluid. The defect is similar to omphalocele; however, in omphalocele, the organs are contained in a thin, membranous sac instead of floating in the amniotic fluid.

The amount of abdominal contents protruding outside of the fetus varies from case to case. Some are very small — just a few loops of bowel — while others can be quite large, involving most of the intestine and stomach.

Most babies with gastroschisis are born to mothers in their late teens or early twenties. The cause of the defect is unknown.

Gastroschisis ranges in severity, depending on the condition of the intestine. Fortunately, most fetuses with gastroschisis do not have severe damage to the intestine before birth. The relatively normal intestine can be returned to the abdomen and the defect closed with one or two surgeries shortly after birth. These babies will still be in the intensive care nursery for several weeks before the intestines work well enough to allow for feeding and discharge home. However, these babies eventually feed and grow normally.

Ten to twenty percent of fetuses with gastroschisis have significant damage to the intestine that greatly complicates their course after birth and, occasionally, can be fatal. Babies born with damaged intestine can have a very difficult and prolonged stay in the intensive care nursery. These babies often require several operations to return the intestine to the abdomen using a plastic silo and eventual closure of the abdominal wall. The bowel can be so damaged that parts of it have to be removed.

In the worst cases, there may not be enough bowel left to absorb food. The most severely affected babies may not survive, and others may be left with "short bowel syndrome." At the very least, these babies will require nutritional support in the nursery for many months.

An ultrasound can be used to accurately diagnose gastroschisis and distinguish it from similar conditions, such as omphalocele. However, it can't determine the severity of the bowel damage. It may be necessary to perform ultrasounds every few weeks to see if the bowel outside the fetus's body becomes dilated, develops a thick wall or loses some blood flow.

Since eight of 10 babies with gastroschisis don't have damaged bowel and do fine after birth, it is important to identify the two babies who will have badly damaged bowel and may benefit from fetal intervention before birth. At UCSF, we follow all fetuses with a careful ultrasound examination every week or two to look for any change in the bowel.

Monitoring the Baby and Preparing for Delivery

Babies with gastroschisis should be carefully monitored throughout the pregnancy for intrauterine growth retardation — not growing enough while in the womb — and for damage to the intestines. Intestines can be damaged by exposure to the amniotic fluid or by impaired blood flow to the exposed intestine.

Since most fetuses with gastroschisis do well with regular ultrasound observation and near-term delivery at an appropriate hospital, the most important decisions relate to where to deliver and the medical team who will care for your baby before and after birth.

Babies with gastroschisis should be delivered at a center where the intestines can be immediately covered and kept warm and moist until surgical repair or silo placement can be performed. The biggest threat to the baby and to the intestine's condition is to have to transport the baby to another medical center or in any way delay the repair.

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Reviewed by health care specialists at UCSF Benioff Children's Hospital.

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Intensive Care Nursery
1975 Fourth St., Third Floor
San Francisco, CA 94158
Phone: (415) 353-1565
Fax: (415) 353-1202

Fetal Treatment Center
1855 Fourth St., Second Floor, Room A-2432
San Francisco, CA 94158
Phone: (800) 793-3887
Fax: (415) 502-0660
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Surgery Clinic
1825 Fourth St., Fifth Floor, 5B
San Francisco, CA 94158
Phone: (415) 476-2538
Fax: (415) 476-2929
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