The role of labor in gastroschisis bowel thickening and prevention by elective pre-term and pre-labor cesarean section

Twelve consecutive cases of gastrochisis seen during the past 3 years are reported. Four were managed by elective pre-term and pre-labor cesarean section as soon as lung maturity was established by biochemical means and 8 by delivery after the onset of labor, 4 by vaginal delivery and 4 by cesarean section. There was no intestinal thickening or “peel” in any of the 4 infants born by elective pre-term and pre-labor section. All were quickly and easily repaired (the last 3 with umbilicus preservation) with no associated atresias or stenosis and with minimal length of hospitalization. The 8 cases delivered after the onset of labor all had marked instestinal thickening, 2 (25%) had severe and extensive intestinal necrosis or atresias (“apple-peel”), and 1 died (12.5%). All had prolonged and complicated hospital stays with multiple operations. The routine use of elective pre-term and pre-labor section in all cases of gastroschisis diagnosed prenatally by α-fetoprotein (AFP) screening and ultrasound is strongly recommended, as are routine AFP screening and ultrasound studies during pregnancy.