title: Gastroschisis, destructive brain lesions, and placental infarction in the second trimester suggest a vascular pathogenesis.
abstract: The cause and pathogenesis of gastroschisis are uncertain. We report the autopsy and placental pathology of a stillbirth at 20 gestational weeks, in which gastroschisis was accompanied by destructive lesions in the cerebral cortex and brainstem, as well as cardiac calcification, consistent with ischemic injury during the 2nd trimester. An important potential underlying mechanism explaining the fetal abnormalities is the presence of infarcts in the placenta, indicative at this gestational age of maternal vascular underperfusion. The association of gastroschisis with ischemic lesions in the brain, heart, and placenta in this case supports the concept that gastroschisis, at least in some instances, may result from vascular event(s) causing disruption of the fetal abdominal wall and resulting in the extrusion of the abdominal organs, as well as hypoxic-ischemic brain and cardiac injury.
authors.affiliation: 1  Department of Pathology (Neuropathology), Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Folkerth
authors.forename: Donald M
authors.initials: DM
authors.lastname: Habbe
authors.forename: Theonia K
authors.initials: TK
authors.lastname: Boyd
authors.forename: Kristin
authors.initials: K
authors.lastname: McMillan
authors.forename: Jessica
authors.initials: J
authors.lastname: Gromer
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sens
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Elliott
mesh_terms: D034861:Abdominal Wall / Q000002:abnormalities / Q000098:blood supply; D001921:Brain / Q000002:abnormalities*; D005260:Female; D005333:Fetus; D020139:Gastroschisis / Q000473:pathology*; D006330:Heart Defects, Congenital / Q000473:pathology; D006801:Humans; D007238:Infarction / Q000150:complications / Q000473:pathology; D010920:Placenta / Q000098:blood supply*; D010922:Placenta Diseases / Q000473:pathology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D050497:Stillbirth
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