EP06.76: A case of gastroschisis with reversible reversed flow of umbilical artery, thought to be due to compression of the umbilical cord

Gastroschisis is a rare disease caused by congenital defect of the anterior abdominal wall, which is known to be associated with a high frequency of intrauterine fetal death and fetal growth restriction, and is thought to be caused by cord compression due to organs escaping from the abdominal cavity. In this case, we experienced a fetus of single umbilical artery associated with simple gastroschisis, in which the umbilical cord blood flow reversibly changed from normal waveform to diastolic reversed waveform within a short period of time. The patient, a 34-year-old primipara, her fetus was diagnosed with simple gastroschisis at 20 weeks' gestation due to a right-sided hiatus in the umbilical region and prolapse of the intestinal tract, and a single umbilical artery due to a defect in the left umbilical artery. At 24 weeks 0 days of gestation, intrauterine fetal growth restriction, reversed diastolic blood flow of umbilical artery, and bradycardia were observed, but when the patient was examined again three days later, the umbilical cord artery blood flow had a normal waveform and a normal fetal heart rate. When the patient was examined again at 25 weeks 6 days gestation, intrauterine fetal death was confirmed. In this case, because of the single umbilical artery, the umbilical blood flow changed dynamically from normal waveform to diastolic reversed waveform due to the pressure caused by the organ that escaped through the abdominal defect. Ultimately, intrauterine fetal death occurred, which was also considered to be an umbilical cord blood flow obstruction. Since this condition can occur in all cases of simple gastroschisis, the umbilical cord blood flow disturbance may be the cause of intrauterine fetal death and fetal growth restriction as in the present case. This case suggests the need to focus on changes caused by compression of the umbilical artery as part of the perinatal management of gastroschisis.