Question
A 19-year-old woman, gravida 1, para 0, at 21 weeks’ gestation comes to the physician for a follow-up prenatal visit. At her previous appointment, her serum a-fetoprotein concentration was elevated. She had smoked 1 pack of cigarettes daily for 3 years but quit at 6 weeks’ gestation. Examination shows a uterus consistent in size with a 21-week gestation. Ultrasonography shows fetal viscera suspended freely into the amniotic cavity. Which of the following is the most likely diagnosis?
| A. |
Vitelline fistula
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| B. |
Diaphragmatic hernia
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| C. |
Omphalocele
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| D. |
Gastroschisis
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Show Answer
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Correct Answer � D
Explanation
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|
Answer D) Gastroschisis
Failure of lateral fold closure leads to a full-thickness abdominal wall defect that allows the growing bowel to herniate through at the weakest point.
Gastroschisis
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Gastroschisis is a congenital ventral wall defect that leads to intestinal herniation through the involuted right umbilical vein, the weakest part of the fetal abdominal wall.
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As gastroschisis is an uncovered abdominal wall defect, a-fetoprotein (AFP) can diffuse freely into the amniotic fluid and maternal circulation, leading to elevated maternal serum AFP, which can be used as a screening test.
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As a confirmatory test, fetal ultrasound will show free-floating bowel without a membranous sac.
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Risk factors include young maternal age (i.e., under 20 years of age), and tobacco and alcohol use during pregnancy. Initial treatment of a newborn with gastroschisis includes placing the extruded abdominal contents in a protective silo, nasogastric decompression, and immediate surgical correction.
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