Omphalocele 1

Diagnosis of Fetal Omphalocele

Assignment to Center coordinator - prenatal records obtained

Notification of Texas Childrens Fetal Center physicians on call for the week

NICHD CMA Study

Assess whether genetic counseling has been undertaken (18 weeks gestation)
NO

YES

- Genetic counseling @ Baylor (consider amniocentesis for karotype and CMA) - Comprehensive ultrasound

Psychosocial stressors, family functioning, neurodevelop outcome study

Gestational age of > 20 weeks

Comprehensive ultrasound @ Baylor if referred by OB or non-Houston MFM

TCH DI US and MRI

Fetal echocardiogram

Pediatric surgery consultation

Presentation at weekly multidisciplinary conference

Continue omphalocele 2 algorithm

Approved10/06/2008 Copyright Texas Childrens Fetal Center

The algorithms contained on this Web page have been developed for the purpose of unifying the general care of patients. They are not intended to serve as a rigid protocol or a written proxy for the standard of care. These are not intended to impose standards of care preventing selective variances from the guidelines to meet the specific and unique requirements of individual patients. These algorithms do not preclude the use of the physician's clinical judgment in a specific situation. The algorithms remain the intellectual property of Texas Children's Hospital. They cannot be reproduced in whole or in part without the expressed permission of Texas Children's Hospital. Texas Childrens Hospital. All rights reserved.

Omphalocele 2

Continuation from omphalocele 1 algorithm

Ultrasounds Q 3 weeks for fetal growth

Initial prenatal transfer of OB care visit before 28 weeks gestation

Comprehensive US @ Baylor if not yet performed

Start 2X week biophysical profiles @ 32 weeks gestation

32 34 weeks gestation

Repeat MRI if needed

Repeat fetal echocardiogram if needed

Follow-up pediatric surgery consultation

Neonatology consult and NICU tour

Labor and Delivery tour

Representation at weekly multidisciplinary conference for plan of delivery

Consider delivery by 40 weeks gestation

Consider vaginal delivery if omphalocele does not contain liver

Consider Cesarean section delivery if omphalocele contains significant amount of liver Approved 10/06/2008 Copyright Texas Childrens Fetal Center

The algorithms contained on this Web page have been developed for the purpose of unifying the general care of patients. They are not intended to serve as a rigid protocol or a written proxy for the standard of care. These are not intended to impose standards of care preventing selective variances from the guidelines to meet the specific and unique requirements of individual patients. These algorithms do not preclude the use of the physician's clinical judgment in a specific situation. The algorithms remain the intellectual property of Texas Children's Hospital. They cannot be reproduced in whole or in part without the expressed permission of Texas Children's Hospital. Texas Childrens Hospital. All rights reserved.