Fetal Repair of Complex Gastroschisis: A Safety and Feasibility Trial

The goal of this clinical trial is to evaluate the safety and feasibility of fetal repair of complex gastroschisis (GS) via a fetoscopic surgical approach by assessing maternal, fetal, neonatal, and infant outcomes in a cohort of 10 patients. The hypothesis is that in utero repair of GS will reduce postnatal mortality and morbidity in complex GS infants with minimal maternal and fetal risk.

Inclusion Criteria:Pregnant women - maternal age 18 years or older and capable of consenting for her own participation in this studySingleton pregnancySonographic evidence of gastroschisis (exteriorization of bowel content outside the fetal abdominal cavity into the amniotic cavity)Intraabdominal bowel dilation ≥ 10 mm at 20-24 weeks GA reviewed by prenatal ultrasoundAbsence of significant associated anomalies* diagnosed on prenatal ultrasound or MRIGestational age at the time of the procedure will be between 20 0/7 weeks and 25 6/7 weeksAbsence of chromosomal and clinically significant abnormalities, i.e., normal karyotype and/or normal chromosomal microarray (CMA) by invasive testing (amniocentesis or Chorionic Villus Sampling (CVS)). If there is a balanced translocation with normal CMA with no other anomalies the candidate can be included. Patients declining invasive testing will be excludedThe family has considered and declined the option of termination of the pregnancy at less than 24 weeks and of standard postnatal treatmentThe family meets psychosocial criteria (sufficient social support, ability to understand the requirements of the study)Parental/guardian permission (informed consent) for follow up of the child after birthSignificant associated anomalies are defined as such anomalies that would, in and of themselves, be life limiting or life threatening. A minor anomaly, such as a small VSD or ASD not deemed to be life limiting or threatening, or a cleft lip or other such anomaly, unless part of a genetic syndrome, will not disqualify the patient.Exclusion Criteria:Significant fetal anomaly unrelated to gastroschisisEvidence of bowel perforation (presence of intraabdominal bowel calcification on ultrasonography)Increased risk for preterm labor including short cervical length (≤ 2.0 cm), history of incompetent cervix with or without cerclage, and previous preterm birth in a singleton pregnancy (other than a patient delivered for a non-repeating medical or surgical indication)Placental abnormalities (previa, abruption, accreta) known at time of enrollmentPre-pregnancy body-mass index (BMI) ≥40Contraindications to surgery including previous hysterotomy (whether from a previous classical cesarean, uterine anomaly such as an arcuate or bicornuate uterus, major myomectomy resection, or previous fetal surgery) in active uterine segmentTechnical limitations precluding fetoscopic surgery, such as extensive uterine fibroids, fetal membrane separation, or uterine anomaliesMaternal-fetal Rh alloimmunization, Kell sensitization, or neonatal alloimmune thrombocytopenia affecting the current pregnancy.Maternal HIV, Hepatitis-B, Hepatitis-C status positive because of the increased risk of transmission to the fetus during maternal-fetal surgery. If the patient's HIV or Hepatitis status is unknown, the patient must be tested and found to have negative results before enrollmentMaternal medical condition that is a contraindication to surgery or general anesthesiaLow amniotic fluid volume (Amniotic Fluid Index less than 6 cm) if deemed to be due to fetal anomaly, poor placental perfusion or function, or membrane rupture. Low amniotic fluid volume that responds to maternal hydration is not an exclusion criterionPatient does not have a support person (i.e., spouse, partner, or mother) available to support her for the duration of the pregnancyInability to comply with the travel and follow-up requirements of the trialPatient scores as severely depressed on the Edinburgh Postnatal Depression Scale (EPDS)Patients that are enrolled or have been enrolled in any another intervention study that affects the mother or fetusMaternal hypersensitivity to any of the entities associated w/ AlloDerm™. The use of AlloDerm™ Regenerative Tissue Matrix distributed by Allergan Aesthetics is contraindicated for patients sensitive to any of the antibiotics listed on the AlloDerm package, i.e., Gentamycin, Cefoxitin, Lincomycin, Polymyxin B and Vancomycin or Polysorbate 20