Abdominal Wall Defects - Monitoring before birth - Fetal diagnosis & treatment - Chop - 5 of 11

>> MONITORING BABIES WITH ABDOMINAL WALL DEFECTS IS CRUCIAL TO MAKING SURE THAT YOU GET THE BEST OUTCOME. >> FOR SURVEILLANCE OF GASTROSCHISIS THERE ARE SEVERAL IMPORTANT THINGS TO FOLLOW. THERE'S ABOUT A 5% RATE OF INTRAUTERINE FETAL DEMISE DURING THE THIRD TRIMESTER. SO THE PROTOCOL THAT WE INSTITUTE HERE IS ROUTINELY BEYOND 30 TO 32 WEEKS GESTATION. WE DO TWICE WEEKLY SONOGRAPHIC SURVEILLANCE, WE ARE DOING BIO-PHYSICAL PROFILES AND NON-STRESS TESTING BECAUSE WE WANT TO MAKE CERTAIN THE FETUS IS NOT GETTING INTO TROUBLE OR IT'S NOT AT RISK TO DIE BEFORE BIRTH. IT'S IMPORTANT TO FOLLOW FETAL GROWTH BECAUSE THESE FETUSES FOR WHATEVER REASON TEND TO BE SMALL AND MAYBE DUE IN PART TO LOSS OF PROTEIN FROM THE EXTRUDED BOWEL INTO THE AMNIOTIC FLUID. >> AT 32 WEEKS WE WERE COMING IN TWICE A WEEK. AND THAT'S WHEN IT REALLY KIND OF HIT US THAT, YOU KNOW, AT LEAST HIT ME THAT, YOU KNOW, IT WAS GETTING CLOSER AND CLOSER. >> THE OTHER THINGS TO FOLLOW WITH GASTROSCHISIS ARE THE APPEARANCE OF THE BOWEL. BECAUSE THE BOWEL DUE TO THE AMNIOTIC FLUID EXPOSURE OR DUE TO CONSTRICTION AT THE ABDOMINAL WALL DEFECT CAN CAUSE BOWEL DAMAGE. >> AND AS THE BABY GROWS AND THAT DEFECT BECOMES MORE RESTRICTIVE OR CONSTRICTING, IT CAN ACTUALLY INTERFERE WITH BLOOD FLOW OUT TO THE BOWEL OR IT CAN INTERFERE WITH BLOOD FLOW BACK FROM THE BOWEL. >> AND THAT CAN CAUSE A PIECE OF THE INTESTINE TO DIE LEADING TO WHAT'S CALLED INTESTINAL ATRESIA. SO THE CONSEQUENCES OF A DEFECT IN THE ABDOMINAL WALL, IF IT'S TOO SMALL, CAN BE FAIRLY DEVASTATING. >> ENTENZO HAD ABOUT, I THINK, IT WAS FIVE DIFFERENT THINGS THAT HE HAD TO ACCOMPLISH DURING THE ULTRASOUND AND THEN A NON-STRESS TEST. THEY WOULD JUST HOOK ME UP TO A MONITOR THAT WOULD CHECK HIS HEART RATE AND WOULD ALSO SEE IF I WAS HAVING CONTRACTIONS. HIS HEART RATE HAD TO INCREASE WHEN HE MOVED. AND WHAT GAVE IT AWAY THE DAY THAT I HAD HIM WAS HIS HEART RATE WAS ELEVATED AND IT DIDN'T CHANGE. >> WITHIN A FEW MINUTES THEY BASICALLY CAME BACK IN AND SAID, "YOU'RE DELIVERING A BABY TODAY." >> SO THINGS CAN CHANGE QUITE RAPIDLY. AND IT'S IMPORTANT TO HAVE THE TEAM THAT CAN MOBILIZE QUICKLY AGAIN TO GET THE BEST OUTCOME FOR MOTHER AND BABY. >> FOR OMPHALOCELE ONCE THE WORKUP IS DONE INCLUDING KARYOTYPING IT'S IMPORTANT TO DO SERIAL SONOGRAPHIC SURVEILLANCE PARTICULARLY FOLLOWING FOR FETAL GROWTH. >> WE WENT THROUGH FIVE MONTHS OF CONTINUAL TESTING. >> ONE OF THE THINGS THAT WE LOOK FOR PRENATALLY WITH GIANT OMPHALOCELES IS HOW IS THE CHEST GROWING. >> BECAUSE GIANT OMPHALOCELES ARE ASSOCIATED WITH RELATIVE PULMONARY HYPOPLASIA, SMALL LUNGS WHICH OBVIOUSLY CAN AFFECT PROGNOSIS. >> IF THE CHEST IS WAY BEHIND IN SIZE THEN WE KNOW THAT THESE ARE BABIES THAT ARE GOING TO HAVE BIG, BIG TROUBLE BREATHING. >> SO WE'RE WORKING HARD THESE DAYS BY ULTRASOUND AND BY MRI TO TRY TO JUDGE FETAL LUNG SIZE. AND ONE ADVANTAGE THAT NEWBORNS AND FETUSES HAVE IS THAT THEY CAN HAVE REMARKABLE COMPENSATORY LUNG GROWTH PARTICULARLY AFTER BIRTH ONCE THE OMPHALOCELE IS CLOSED SO THAT THEY CAN EVENTUALLY LEAD NORMAL LIVES. >> IT'S ONE OF THE HALLMARKS OF OUR CENTER THAT WE FOLLOW MOTHERS AND THEIR BABIES SO CLOSELY TO ENSURE THE BEST OUTCOME.