Is your baby's intestines sticking out? Let's talk about this rare condition (Gastroschisis)

If you are a mother-to-be, you probably worry about the health of your unborn baby. Sometimes, after a scan, the doctor says something serious, and it is normal to feel a lot of fear and anxiety. Today we are talking about a very rare birth defect that is a little scary, but can have good outcomes if managed properly. This condition is called Gastroschisis (GAS-tro-schi-sis).

Simply put, what is Gastroschisis?

Gastroschisis is a condition in which a baby is born with a hole just below their belly button, through which the intestines and sometimes other organs, such as the liver and stomach, protrude. Think about it, when a baby is first growing in the womb, the abdominal muscles do not develop properly. This small gap allows these organs to emerge.

Babies with this condition require surgery at birth. They also need to stay in the Neonatal Intensive Care Unit for a short time before and after the surgery. As parents, this can be scary, but most babies recover well after surgery.

What is the difference between Gastroschisis and Omphalocele?

Both of these conditions are rare conditions in which organs emerge through a hole in the baby's abdomen. But there are clear differences between the two. See the table below to understand the difference.

Your obstetrician can diagnose either of these conditions during a routine scan during pregnancy.

What are the symptoms of this condition?

You may not feel any symptoms during pregnancy. This is only detected through a scan of the baby. The doctor may see things like this during the scan:

• The baby's organs, such as the intestines and stomach, appear to be floating outside the body.
• The intestines are swollen or twisted together.
• Sometimes the baby's body temperature drops (Hypothermia).

What are the causes of Gastroschisis?

There is no single specific cause for this yet. In most cases, it is the result of a combination of factors. Here are some factors that have been identified as increasing the risk:

• Pregnancy at a young age: The risk is especially high for teenage mothers.
• Smoking: Smoking during pregnancy, especially in the early months.
• Alcohol consumption: Alcohol use during pregnancy.
• Use of certain medications or drugs.
• Low maternal body mass index (BMI): Abnormal weight loss in the mother during pregnancy.
• Infections such as urinary tract infections: The mother has had conditions such as urinary tract infections 3 months before pregnancy or during the first 3 months of pregnancy.
• Changes in the baby's genes or chromosomes.

How to recognize this condition?

This condition can often be detected during a scan between 18 and 20 weeks of pregnancy. The main tests used for this are:

• Ultrasound: This is the main method of diagnosis. The baby's organs can be clearly seen floating in the womb.
• Mother's blood test:Sometimes the mother's blood is tested for a protein called alpha-fetoprotein (AFP). If the level is very high, gastroschisis is suspected. This is then confirmed with a scan.
• Fetal Echocardiogram: This is also a special scan. Some babies with gastroschisis may also have heart problems. Therefore, this scan is done to check the baby's heart function.

If the baby has Gastroschisis, how is it managed during pregnancy?

If your baby is diagnosed with this condition, you and your baby will need special attention. Your doctor will refer you to a team of specialists.

• Maternal-fetal medicine specialist: A doctor who specializes in high-risk pregnancies.
• Neonatologist: A doctor who specializes in newborn babies, especially those who are sick or premature.
• Pediatric surgeon: This doctor's advice is essential because surgery is required as soon as the baby is born.

During this time, you will need to have frequent scans to monitor your baby's development. You may also be advised to count your baby's movements (the number of movements) for about two hours a day, starting around 26 weeks.

How is it treated?

The treatment for gastroschisis is surgery .

Often, doctors decide to induce labor a little earlier than normal, between 35 and 37 weeks. This condition does not necessarily mean a cesarean section, but it is important to plan for delivery in a hospital with a neonatal intensive care unit (NICU) because the baby will need specialized care once it is born.

As soon as the baby is born, surgery is performed to put the organs that have come out back into the abdomen and close the hole. There are two main methods for performing this surgery.

1. Primary Repair (single surgery): If the number of organs that have come out is small and they are not severely damaged, the organs are put back in in a single surgery immediately after birth and the abdomen is closed.

2. Staged Repair: This procedure is used if many of the organs have come out or are swollen. In this procedure, the baby's organs are placed in a special protective plastic bag (called a 'silo') right after birth. This protects the organs. Then, the organs are gradually pushed back into the abdomen over a period of several days. Once they are fully inserted, the hole is closed surgically.

After the surgery, the baby will be put on a ventilator to help him breathe due to the high pressure inside his abdomen.It may be necessary to connect. Also, until the intestines start working properly, the baby will need to be fed through a vein (IV). This may require the baby to stay in the hospital for several weeks, or even longer.

What complications can occur due to this condition?

Exposure to amniotic fluid can damage the intestines. As a result, some babies may experience problems such as:

• Difficulty digesting food and absorbing nutrients.
• Intestinal atresia.
• Twisting of the intestines (Volvulus).
• Tissue damage due to blockage of blood flow to the intestine (infarction).

Even after surgery, problems such as infections and difficulty eating may occur. However, all of these are closely monitored by the medical team.