Gastroschisis: A review of practice
Gastroschisis is an abdominal wall defect in the fetus, affecting as many as 1 in 2000 pregnancies. This is a complex medical condition that is growing in prevalence worldwide, and one to which midwives will inevitably be exposed. There is a lack of consensus in the literature as to the cause of gastroschisis and for clear evidence-based treatment regarding indication and timing of birth. While it is agreed that specialist multidisciplinary collaboration is needed from pre-conception, through antenatal surveillance, and into labour, birth and postnatal care, the research is medically led, with no description of a midwifery role. In acknowledging that gastroschisis is a complex medical issue, specific medical and surgical interventions are not examined, but instead a midwifery plan of care within the multidisciplinary approach is derived from the available literature.
Gastroschisis is an abdominal wall defect in the fetus, affecting as many as 1 in 2000 pregnancies and growing in prevalence worldwide (Lepigeon et al, 2014). It occurs during the first trimester, and is caused when loops of bowel herniate outside the abdominal cavity in the amniotic fluid. This places the fetus at an increased risk of further complications, such as preterm labour, intra-uterine growth restriction (IUGR), fetal death in utero, bowel atresia, ischemia and volvulus (Carnaghan et al, 2016). The bowel continues to grow and develop outside the abdomen (Moore-Olufemi et al, 2015) until the fetus is born. At this point, immediate specialist intervention is needed because the exposed bowel places the neonate at risk of dehydration, hypothermia and infection (Lepigeon et al, 2014).
The contemporary literature acknowledges an increase in the global prevalence of gastroschisis in the past 30 years; however, a recent study suggests that there has been a significant stabilisation of figures, and in fact, a slight decrease has been noted (Allman et al, 2016). Research conducted in the USA found that the prevalence rate affected all demographics of age and ethnicity; however, Indigenous women in North America, Hawaii and the Pacific had higher rates of babies born with gastroschisis (Rocha et al, 2014).
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