Influence of amnioinfusion in a model of in utero created gastroschisis inthe pregnant ewe

Objective: Recent studies on the management of human fetal gastroschisis ha ve produced two major findings: (1) there is an inflammatory response in th e amniotic fluid of these fetuses, and (2) amniotic fluid exchange designed to disrupt the inflammatory loop seems to have a favorable impact on the i mmediate and late outcome of these early operated neonates. To test this hy pothesis, we used serial amniotic fluid exchanges in a model of gastroschis is developed in the ewe. Methods: Gastroschisis was created at midgestation in 21 lamb fetuses by an in utero technique. Saline was amnioin-fused in s ome fetuses every 10 days to term. Fetuses were sacrificed on day 145 by ce sarean section. Extraabdominal bowels with fibrous peel were processed for histologic examination. Comparisons were done between fetuses without gastr oschisis (controls), fetuses with gastroschisis and amnioinfusion, and fetu ses with gastroschisis without amnioinfusion, Results: Of 21 fetuses operat ed, 8 died in utero or were stillborn; 5 were not amnioinfused, and 8 under went amnioinfusion. Thickness of bowel muscularis (mu m) was 92.6 +/- 20.2 for controls, 126.2 +/- 21 for the amnioinfused fetuses, and 182.8 +/- 58.3 for the nonamnioinfused fetuses (p = 0.001). The same significant results were obtained for thickness of serous fibrosis (p = 0.02) and plasma cell i nfiltration (p = 0.015). Conclusions: We have created a model of gastroschi sis suitable for experimentation in the fetal sheep. Our amnioinfusion data in this model indicate a clear improvement of the deleterious process. Thi s finding correlates well with recent data on amnioinfusion as a therapeuti c approach to human gastroschisis. Copyright (C) 2000 S. Karger AG, Basel.