Obgyn Oral Boards - Fetal Ventral Abdominal Wall Defects

Front 1

What are the most common fetal ventral abdominal wall defects?

Back 1

Omphalocele and gastroschisis

Front 2

What is a gastroschisis?

Back 2

Gastroschisis can be pathological or physiologic. Physiologic herniation prevents accurate diagnosis before 12 weeks of gestation.

Gastroschisis is a full-thickness defect in the ventral abdominal wall. Loops of intestine are seen within the amniotic fluid without overlying membrane.

Gastroschisis is associated with higher levels of maternal serum alpha fetoprotein than omphaloceles and neural tube defects.

Front 3

What is an omphalocele?

Back 3

And omphalocele is a midline ventral abdominal wall defect through which abdominal contents herniate. The defect usually occurs at the base of the umbilicus. The umbilical cord usually inserts at the apex of the omphalocele.

Front 4

What are the risks of chromosomal abnormalities with omphalocele and gastroschisis?

Back 4

Gastroschisis does not appear to be an increase risk for chromosomal abnormalities.

Omphalocele is associated with up to 60% of chromosomal abnormalities when the liver is not included.

Front 5

What are delivery and treatment considerations for gastroschisis?

Back 5

Fetuses with gastroschisis can be delivered vaginally at or near term. Immediate repair and closure lessons problem such as infections, hydrothermia, and acidosis. Primary closure is possible when the bowel can be returned to the abdominal cavity which is about 80% of cases. Otherwise a silo is used to protect the bowel and surgical repair is performed later.

Front 6

What are treatment options for omphalocele?

Back 6

Fetuses with small omphaloceles can be delivered vaginally. Fetuses with defects larger than 5 cm are typically delivered by cesarean section. Primary surgical closure is usually performed for smaller omphaloceles. Silos, elastic bandages, and epithelialization with delayed surgical repair are used for larger defects.

Front 7

What other malformations are omphaloceles associated with?

Back 7

50% of omphaloceles are associated with cardiac defects. omphaloceles may also be associated with amniotic band syndrome, pentalogy of Cantrell, Beckwith-Wiedemann syndrome, and cloacal exstrophy.

Front 8

What is pentalogy of Cantrell?

Back 8

Pentalogy of Cantrell is characterized by a median super umbilical abdominal wall defect, defect in the sternum, diaphragmatic pericardial deficiency, anterior diaphragmatic deficiency, and intracardiac defects. It has been associated with with cystic hygroma, cranial defects, and chromosomal abnormalities.

Front 9

What is body stalk anomaly?

Back 9

Body stock anomaly is characterized by cranial, midline facial, thoracic, abdominal wall, and limb defects.

By ultrasound, the intrathoracic and abdominal organs may be seen outside of the body cavities within a Sac covered by membranes and directly attached to the placenta with an absent or shortened umbilical cord.

Front 10

What is cloacal exstrophy?

Back 10

This presents with hypogastric omphalocele, meningiomyelocele, bladder herniation, scoliosis, and abnormalities of the renal and genitourinary system. A single umbilical artery is often Associated and as are spinal and skeletal defects.

Front 11

What are your urachal abnormalities?

Back 11

These are defects in the urachus. Which normally connects the bladder to the umbilicus. This can cause abnormal communication between the anterior abdominal wall and bladder. They may appear as complete or partially patent urachus, urachal diverticulum, urachal sinus or cyst.