Presentation
Primigravida now at thirty three weeks. For fetal anomaly scan, gestation, placentation, Doppler indices and biophysical profile score.
Patient Data
Non-encapsulated fetal bowel loops herniates through the ventral fetal abdominal wall at the para-umbilical region and freely floats within the chorionic space/amniotic liquor. The fetal gastric content exhibit a double bubble appearance at the pyloro-duodenal junction. There is polyhydramnios (amniotic fluid index = 31.73 cm). No other gross fetal anomaly or features of growth restriction.
Case Discussion
Cocooning and matted freely floating fetal bowel loops within the amnion advocating for fetal gastroschisis with attendant polyhydramnios. The double bubble gastric appearance seen may be concerning for partial duodenal atresia. Incidental, single twist loose loop of the umbilical cord rounding the posterior fetal neck with a U-shaped appearance (type -A loose nuchal cord) is noted.
Gastroschisis reportedly has an incidence of 1:2000-1:5000, is more prevalent in young mothers and is associated with polyhydramnios1.