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FETAL ABDOMINAL WALL DEFECT
Category: Pediatric Surgery
Abstract : Fetal Abdominal Wall Defect : Most common abdominal wall defects (AWD) are gastroschisis, omphalocele and hernia of the umbilical cord. Referral to tertiary centers with available neonatal intensive care is necessary in prenatally diagnosed cases. Changing the route of delivery does not affect outcome for either defect. Omphalocele has a high incidence of associated anomalies (cardiac, neurogenic,
Fetal Abdominal Wall Defect : Most common abdominal wall defects (AWD) are gastroschisis, omphalocele and hernia of the umbilical cord. Referral to tertiary centers with available neonatal intensive care is necessary in prenatally diagnosed cases. Changing the route of delivery does not affect outcome for either defect.
Omphalocele has a high incidence of associated anomalies (cardiac, neurogenic, genitourinary, skeletal, chromosomal syndromes) that are the cornerstones of mortality. Detailed search for associated anomalies, fetal echocardiogram and karyotyping should be performed always. Cesarean section is justified in large omphaloceles (> 5 cm) to avoid liver damage, sac rupture and dystocia. Gastroschisis prenatal US appearance depends on gestational age and condition of extruded bowel. Fetal karyotyping testing is less important. Intestinal atresia complicates the defect, the result of an intrauterine vascular accident. Intestinal obstruction due to atresia or luminal constriction may cause polyhydramnios, fetal growth retardation and preterm labor, findings that can be monitored with serial US. No benefit has been found in recommending routine c-section for most cases of gastroschisis. Preterm deliveries by c-section have been found to prevent bowel damage in fetus with progressive bowel dilatation and thickening, a finding that has not been corroborated by others. Abnormal US appearance of fetal bowel is associated with more bowel edema, longer operative time and a higher incidence of postoperative complications.
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