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  • What can be done before birth?

  • There is no reason to treat omphaloceles before birth (i.e., try to operate on the fetus). However, some measures can be taken once an omphalocele has been diagnosed by ultrasound. Additional diagnostic tests may be necessary, particularly with omphalocele: an amniocentesis may be indicated, with chromosomal analysis, and efforts should be made to detect heart anomalies. The course of the pregnancy can be altered in three ways:

    • Mode of delivery
       
      Normal delivery is recommended unless there are obstetrical reasons to proceed with a C-section. The main exception may be cases of "giant omphalocele," where a large portion of the liver is exposed as well: here, there may be an increased risk of liver trauma with vaginal delivery.

    • Place of delivery
       
      As long as he or she is inside the womb, the fetus with an omphalocele is relatively well shielded from trauma and complications. After birth, however, the exposed intestines and/or liver have to be protected from direct trauma and infection. Because of this, it is recommended that deliveries take place in such an institution that specializes in such births, like Hasbro Children's Hospital.

    • Time of delivery
       
      One of the concerns with omphalocele is that the exposed bowel becomes so damaged that function is impaired and the baby may need to stay in intensive care for a long time. Many infants with gastroschisis have what appears to be damaged bowel, with very thick, rigid loops of intestines containing a "peel." One of the theories for this peel (and for the fact that some babies have little or no peel at all) is that prolonged exposure of the bowel to the amniotic fluid causes progressive damage. In other words, limiting the amount of time that the bowel is floating in this fluid (or even diluting that fluid by infusing sterile saline water inside the womb) could decrease the amount of peel and intestinal damage.

    In omphaloceles, this is rarely a problem, because a membrane envelops the organs and shields them from exposure. However, that membrane can rupture, exposing the intestines to the same potential trauma as with gastroschisis.

     


    The Fetal Treatment Program is a partnership of Hasbro Children's Hospital, Women & Infants' Hospital and The Warren Alpert Medical School of Brown University.