Gastroschisis is a defect of the anterior abdominal wall with extrusion of fetal intestine into the amniotic cavity.

The incidence of gastroschisis is approximately 1 in 2500-3000 live births but the incidence is increasing in many developed countries.

The defect in the abdominal wall is usually to the right of the umbilicus. The condition is amenable to prenatal diagnosis as free loops of bowel are seen floating in the amniotic cavity on ultrasound examination. Gastroschisis has an approximate 80-90% detection rate. Gastroschisis is not commonly associated with abnormalities of other organ systems with the exception of small bowel atresia , which may complicate up to 30% cases.

Neonatal surgery of the abdominal defect is required in the immediate neonatal period. Some neonates have primary closure but many infants have a prolonged stay in hospital. The overall mortality is low and the long term survival is 90%. However some neonates have significant morbidity including surgical complications,need for total parenteral nutrition, sepsis and short gut syndrome.

A number of ultrasound predictive factors for poor outcome have been described - these include ultrasound evidence of a dilated stomach, dilatation of the small bowel, thickness of the bowel wall, fetal growth restriction or increased or decreased amounts of amniotic fluid. Unfortunately none of these ultrasound parameters have consistently been correlated with adverse outcome.

The evidence base for ultrasound risk factors, timing, mode and place of delivery will be discussed and illustrated by case discussion.