How to successfully manage the complexities of gastroschisis in pregnancy is the focus of this Women’s Telehealth patient story. [Pictured above: Gastroschisis Baby – Post Op]
This Pregnancy’s Challenge:
At the anatomy ultrasound scan at 17 weeks, the OB physician found that his 24 year old Caucasian patient had a suspected gastroschisis.
Gastroschisis is a birth defect in which the fetus’ intestines and/or stomach protrude outside the abdominal wall. A baby with this condition requires immediate surgery after birth to place the organs in the proper place in the abdominal cavity and close the hole in the abdominal wall. Hospitalization is also needed for an extended period of time to ensure that the baby’s feeding and digestive tract are functioning well. Most babies with appropriate care and surgery at birth will grow up to have normal lives. Successful outcomes often depend on early identification of this birth defect and preparing for surgery upon birth.
In addition to the suspected gastroschisis, other complicating factors included mom’s obesity, pregnancy-induced hypertension, low amniotic fluid, abnormal cervix and active kidney disease. The mom-to-be also needed an extra dose of oversight and compassion due to the loss of a baby during a previous pregnancy, caused by open neural tube defect.
The mom-to-be was referred by the OB physician to Women’s Telehealth maternal-fetal medicine (MFM) physicians for diagnosis and collaborative pregnancy management. Women’s Telehealth was asked to manage BOTH infant and maternal pregnancy complications.
The Team’s Actions:
- The patient was seen multiple times by Women’s Telehealth to assess her baby’s and her own well-being. The severity of the baby’s birth defect was moderate.
- Advanced, serial “live” ultrasound imaging for fetal growth and well-being was performed including: targeted ultrasound scan, fetal echo, BPP, Dopplers, cervical length and AFI measurements.
- Mom was admitted to the hospital for low amniotic fluid once during her pregnancy.
- Mom was counseled for what to do in the event of pre-term labor.
- Women’s Telehealth arranged for a pre-delivery consult with a pediatric surgeon at CHOA in Atlanta, as the baby would be transferred to the pediatric hospital as soon as it was born.
- Women’s Telehealth arranged for a local Atlanta OB GYN group to deliver the baby via C-Section due to the birth defect.
The Results:
- Weekly monitoring by the Women’s Telehealth MFM doctor showed a worsening of the mom’s kidney disease.
- The decision was made to deliver the baby via C-section at 35 weeks at a hospital close to the children’s hospital where the baby would have its surgery and remain for some time.
- A baby girl weighing 6 lbs. 3 oz., with Apgar scores of 8/8, was delivered without incident.
- The baby was promptly transferred to the children’s hospital where successful closure surgery was performed.
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The CDC estimates that Gastroschisis affects 1 in every 1,900 babies born in the U.S. each year. The cause of this birth defect is currently unknown but researchers have speculated that potential causes may be adaptations in genes and/or the lifestyle or environment of the mother. Young, Caucasian women are the most common population to be at risk. For more information about this condition visit: https://www.cdc.gov/ncbddd/birthdefects/gastroschisis.html
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WT partners with OB/GYN physicians and healthcare facilities to provide the highest level of Maternal-Fetal Medicine (MFM) available through telemedicine. WT provides services in local hospitals, doctor’s offices and government clinics.
Our goal in sharing patient case stories is to show the role and possibilities Women’s Telehealth plays in accessing high risk situations and to help turn patient and OB provider concern into the best possible care plans and outcomes for moms and their babies. For more information, call our office at: 404.478.3017