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Pediatric Omphalocele and Gastroschisis Workup Author: James G Glasser, MD, MA, FACS; Chief Editor: Ted Rosenkrantz, MD more... Updated: Apr 28, 2015 Laboratory Studies Elevation of maternal serum alphafetoprotein (MSAFP) is associated with abdominal wall defects. MSAFP levels are greater in gastroschisis than in omphalocele. MSAFP levels are also increased in spina bifida, which additionally increases the ratio of acetylcholinesterase and pseudocholinesterase. [12] Imaging Studies In utero ultrasonography may demonstrate a structural defect that is associated with a karyotypic abnormality. [25] The suspicion that the baby has a genetic abnormality should be confirmed with amniocentesis. Fetal echocardiography may identify a cardiac abnormality. If serial ultrasonography shows dilatation and thickening of the intestine in a baby with gastroschisis, delivery should occur as soon as amniocentesis demonstrates lung maturity. Appropriate tests to determine other congenital anomalies should precede surgical intervention in infants with omphaloceles. Contributor Information and Disclosures Author James G Glasser, MD, MA, FACS Associate Professor of Surgery and Pediatrics, University of South Alabama College of Medicine; Attending Staff, USA Children's and Women's Hospital James G Glasser, MD, MA, FACS is a member of the following medical societies: American Pediatric Surgical Association and Christian Medical & Dental Society Disclosure: Nothing to disclose. Specialty Editor Board David N Sheftel MD, Assistant Professor of Pediatrics, Chicago Medical School at Rosalind Franklin University of Medicine and Science David N Sheftel is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Pediatrics Disclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; EditorinChief, Medscape Drug Reference Disclosure: Nothing to disclose. Brian S Carter, MD, FAAP Professor of Pediatrics, University of MissouriKansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, National Hospice and Palliative Care Organization, and Society for Pediatric Research Disclosure: Nothing to disclose. Carol L Wagner, MD Professor of Pediatrics, Medical University of South Carolina Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research Disclosure: Nothing to disclose. Chief Editor Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal Perinatal Medicine, University of Connecticut School of Medicine Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research

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  • 13/5/2015 PediatricOmphaloceleandGastroschisisWorkup

    http://emedicine.medscape.com/article/975583workup 1/3

    PediatricOmphaloceleandGastroschisisWorkupAuthor:JamesGGlasser,MD,MA,FACSChiefEditor:TedRosenkrantz,MDmore...

    Updated:Apr28,2015

    LaboratoryStudiesElevationofmaternalserumalphafetoprotein(MSAFP)isassociatedwithabdominalwalldefects.

    MSAFPlevelsaregreateringastroschisisthaninomphalocele.

    MSAFPlevelsarealsoincreasedinspinabifida,whichadditionallyincreasestheratioofacetylcholinesteraseandpseudocholinesterase.[12]

    ImagingStudies

    Inuteroultrasonographymaydemonstrateastructuraldefectthatisassociatedwithakaryotypicabnormality.[25]

    Thesuspicionthatthebabyhasageneticabnormalityshouldbeconfirmedwithamniocentesis.

    Fetalechocardiographymayidentifyacardiacabnormality.

    Ifserialultrasonographyshowsdilatationandthickeningoftheintestineinababywithgastroschisis,deliveryshouldoccurassoonasamniocentesisdemonstrateslungmaturity.

    Appropriateteststodetermineothercongenitalanomaliesshouldprecedesurgicalinterventionininfantswithomphaloceles.

    ContributorInformationandDisclosuresAuthorJamesGGlasser,MD,MA,FACSAssociateProfessorofSurgeryandPediatrics,UniversityofSouthAlabamaCollegeofMedicineAttendingStaff,USAChildren'sandWomen'sHospital

    JamesGGlasser,MD,MA,FACSisamemberofthefollowingmedicalsocieties:AmericanPediatricSurgicalAssociationandChristianMedical&DentalSociety

    Disclosure:Nothingtodisclose.

    SpecialtyEditorBoardDavidNSheftelMD,AssistantProfessorofPediatrics,ChicagoMedicalSchoolatRosalindFranklinUniversityofMedicineandScience

    DavidNSheftelisamemberofthefollowingmedicalsocieties:AmericanAcademyforCerebralPalsyandDevelopmentalMedicineandAmericanAcademyofPediatrics

    Disclosure:Nothingtodisclose.

    MaryLWindle,PharmDAdjunctAssociateProfessor,UniversityofNebraskaMedicalCenterCollegeofPharmacyEditorinChief,MedscapeDrugReference

    Disclosure:Nothingtodisclose.

    BrianSCarter,MD,FAAPProfessorofPediatrics,UniversityofMissouriKansasCitySchoolofMedicineAttendingPhysician,DivisionofNeonatology,Children'sMercyHospitalandClinicsFaculty,Children'sMercyBioethicsCenter

    BrianSCarter,MD,FAAPisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanAcademyofHospiceandPalliativeMedicine,AmericanAcademyofPediatrics,AmericanPediatricSociety,AmericanSocietyforBioethicsandHumanities,AmericanSocietyofLaw,Medicine&Ethics,NationalHospiceandPalliativeCareOrganization,andSocietyforPediatricResearch

    Disclosure:Nothingtodisclose.

    CarolLWagner,MDProfessorofPediatrics,MedicalUniversityofSouthCarolina

    CarolLWagner,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,AmericanChemicalSociety,AmericanMedicalWomen'sAssociation,AmericanPublicHealthAssociation,AmericanSocietyforBoneandMineralResearch,AmericanSocietyforClinicalNutrition,MassachusettsMedicalSociety,NationalPerinatalAssociation,andSocietyforPediatricResearch

    Disclosure:Nothingtodisclose.

    ChiefEditorTedRosenkrantz,MDProfessor,DepartmentsofPediatricsandObstetrics/Gynecology,DivisionofNeonatalPerinatalMedicine,UniversityofConnecticutSchoolofMedicine

    TedRosenkrantz,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,AmericanMedicalAssociation,AmericanPediatricSociety,ConnecticutStateMedicalSociety,EasternSocietyforPediatricResearch,andSocietyforPediatricResearch

  • 13/5/2015 PediatricOmphaloceleandGastroschisisWorkup

    http://emedicine.medscape.com/article/975583workup 2/3

    Disclosure:Nothingtodisclose.

    References

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