Fetal Abdominal Wall Defect (Gastroschisis vs Omphalocele)

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Defect-cord relationship + membrane
   Relationship of the defect to the cord insertion + presence of a membrane? (Key differentiation = relationship to the cord insertion + presence of a covering membrane. Ultrafast fetal MRI confirms + surveys associated anomalies (especially CNS), measures O/E lung volume for a giant omphalocele. Physiologic midgut herniation resolves before 11–12 weeks (do not misdiagnose).)
   • Right paraumbilical, free-floating bowel loops, no membrane, raised AFP (gastroschisis) → Gastroschisis · usually isolated
   • Midline, cord inserts into a membranous sac, often contains liver (omphalocele) → Omphalocele · check chromosomes + associated anomalies
   • Complex (LBWC/cloacal exstrophy/pentalogy of Cantrell/bladder exstrophy) → Complex abdominal wall defect
2. [End] Gastroschisis · usually isolated
   Gastroschisis (right paraumbilical, free-floating bowel without membrane, raised maternal AFP): usually isolated (~10% extra-intestinal anomalies, rare chromosomal abnormality); serial monitoring of bowel dilation/wall thickening (bowel injury) + FGR; deliver at a center with pediatric surgery, postnatal primary/staged (silo) reduction; GI complications (atresia/volvulus) up to 25%.
3. [End] Omphalocele · check chromosomes + associated anomalies
   Omphalocele (midline, membranous sac, often contains liver): high risk of chromosomal abnormality (trisomy 13/18/21) and associated anomalies → karyotype/microarray + fetal echocardiography + detailed CNS survey; measure O/E lung volume for a giant omphalocele (pulmonary hypoplasia); assess for BWS (macroglossia/hypoglycemia); prognosis follows associated anomalies, deliver at a specialist center.
4. [End] Complex abdominal wall defect
   Complex abdominal wall defect (limb-body wall complex LBWC, cloacal exstrophy OEIS, pentalogy of Cantrell + ectopia cordis, bladder exstrophy): MRI for comprehensive assessment of extent and associated anomalies + karyotype; widely variable prognosis, usually needs multidisciplinary and genetic counselling; LBWC is mostly lethal.

Source guidelines & references

• Fetal abdominal wall defect prenatal imaging differentiation (RadioGraphics; ultrafast fetal MRI)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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