CMECNE

Gastroschisis – Detection and Implications

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Contrast gastroschisis to an omphalocele
2. Outline the steps to take after gastroschisis is diagnosed on sonogram

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Genoox, Inc., and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2019, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

WHAT IS IT?

Gastroschisis is the presence of intestinal loops in the amniotic cavity due to failure of abdominal body wall closure, typically to the right of the umbilicus
There is no membrane covering the protruding organs, therefore organs are exposed to amniotic fluid and can be damaged
Incidence 1/1800 births per year in USA
Chromosomal abnormalities are not typically associated, unlike omphalocele
- One international study reported chromosomal anomalies in 1.2% (total 3,322 cases) with the most frequent being
  - Trisomy 18 (15 cases) | Trisomy 13 (14 cases) | Sex chromosomes anomalies (4 cases) | Trisomy 21 (2 cases)

KEY CLINICAL POINTS:

Cause of gastroschisis unknown in most cases
Associations have been demonstrated with maternal history of
- Young age and thin body type
- Primipara or primigravida females
- Cigarette smoking in pregnancy
- Poor maternal diet
- Low socioeconomic status
- Maternal use of certain medications (phenylpropanolamine and pseudoephedrine decongestants, salicylates, ibuprofen, acetaminophen)
Prenatal screening and detection is available
- Maternal serum AFP (MSAFP) is elevated
- Amniotic fluid AFP (AFAFP) is elevated
- Possible polyhydramnios detected on prenatal ultrasound
If gastroschisis is detected on ultrasonography
- ACOG guidance recommends offering invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound
- Fetal echocardiography referral
- Ensure detailed anatomy ultrasound that includes visualization of all limbs, to rule out potential syndrome associated with body-stalk disruption
  - Note abdominal opening to the right of the umbilicus
- Minimal recurrence risk 2.5%
Refer to Pediatric surgical specialist to discuss possible surgical correction options, outcomes and long term implications
Develop labor and delivery plan for those who will continue the pregnancy given its high risk nature, and coordinate with NICU and pediatric team as needed
Data suggests better outcomes at perinatal centers that also include surgical teams capable of definitive operative management and NICU availability