Bowel herniates through right-sided abdominal wall defect next to normal umbilical cord insertion site

Newborn classification of gastroschisis

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  Simple: Isolated, no other bowel anomalies

  
  
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  Complex: Bowel atresia, necrosis, perforation, volvulus

Difficult to predict complex gastroschisis in fetus

Free-floating bowel, no covering membrane

Bowel dilatation (> 7-10 mm)

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  Bowel outside of fetus is often dilated and not predictive of bowel pathology

  
  
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  Dilated bowel inside fetus more concerning

  
  
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  > 14-mm bowel diameter most concerning for atresia

Associations: Growth restriction, oligohydramnios

Can make diagnosis in 1st trimester

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  Fetal bowel should be back in abdomen by 12 weeks

Bowel-only omphalocele

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  Bowel not free-floating, covered by membrane

  
  
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  Cord insertion is not normal: Inserts on omphalocele sac

Amniotic band syndrome and body stalk anomaly

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  Multiple fetal defects

Associated with young maternal age

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  Not associated with aneuploidy

Survival for simple gastroschisis approaches 100%

Complex gastroschisis mortality rates 28-50%

Color Doppler shows cord insertion site best

Note appearance of bowel wall

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  Thick, echogenic, matted bowel wall is more concerning

Biophysical profile surveillance later in gestation

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  5% risk of intrauterine fetal demise