Prenatal risk stratification and novel treatments for abdominal wall defects: Insights From the APSA fetal diagnosis and treatment committee on evolving practice

jpedsurg.org

Gastroschisis and omphalocele are congenital abdominal wall defects frequently diagnosed prenatally. Both occur in ∼1 in 4000 live births, although fetuses with omphalocele have a higher risk of in utero demise, which may affect the reported incidence. Although advances in neonatal intensive care, parenteral nutrition, and surgical techniques have reduced perinatal mortality [1], several challenges remain. In gastroschisis, small constricting defects and bowel exposure to amniotic fluid result in inflammation and dysfunction, and current controversies involve optimal timing of delivery, prenatal risk stratification to distinguish simple from complex disease, and assessment of fetal interventions to improve outcomes.

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Article · Oct 2025 · 1 min read

In brief

This article examines prenatal management strategies for gastroschisis and omphalocele, two congenital abdominal wall defects occurring in approximately 1 in 4000 births. It addresses current controversies including optimal delivery timing, risk stratification methods to distinguish simple from complex gastroschisis, and emerging fetal interventions aimed at reducing bowel inflammation and improving neonatal outcomes.

Gastroschisis and omphalocele each occur in ~1 in 4000 live births; omphalocele carries higher risk of in utero demise.
Prenatal risk stratification aims to distinguish simple from complex gastroschisis to guide delivery timing and intervention.
Bowel exposure to amniotic fluid in gastroschisis causes inflammation and dysfunction, driving need for fetal interventions.
Advances in NICU care, parenteral nutrition, and surgical techniques have reduced perinatal mortality for abdominal wall defects.
Key controversies include optimal delivery timing and assessment of fetal interventions to improve gastroschisis outcomes.

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