Omphalocele and Medical Negligence in Chicago
Omphalocele is a congenital abdominal-wall defect in which the intestines, liver, or other organs extend through an opening at the baby’s belly button. The organs are contained within a thin, nearly transparent sac connected to the umbilical cord.
The condition can range from a small opening containing only a portion of the intestine to a large or giant omphalocele involving the liver and several abdominal organs. The size of the defect, the condition of the protective sac, and the presence of other medical problems affect the treatment plan and the child’s outlook.
Most cases of omphalocele are not caused by medical malpractice. The exact cause remains unknown in many pregnancies. Genetic, chromosomal, developmental, maternal, medication-related, and environmental factors may affect risk, but the diagnosis alone does not establish that a physician, hospital, pharmacy, or another party acted negligently.
A legal issue may arise in limited circumstances involving a specific prenatal imaging error, failure to communicate an abnormal result, negligent management of a medication, inadequate delivery planning, delayed newborn care, or preventable harm during surgery or postoperative treatment.
Free legal evaluation: If your concern involves an identifiable medical error rather than the congenital condition alone, contact Sexner Injury Lawyers LLC or call (312) 243-9922.
How an Omphalocele Develops
During early pregnancy, the developing intestines temporarily extend from the abdominal cavity into the base of the umbilical cord. They ordinarily return to the abdomen by approximately the eleventh week of pregnancy.
An omphalocele forms when this return and abdominal-wall development do not occur in the expected manner. The opening is located centrally where the umbilical cord meets the abdomen, and the protruding organs are ordinarily enclosed within a membrane.
The Centers for Disease Control and Prevention currently estimates that approximately 1 in every 3,704 babies in the United States is born with an omphalocele.
Additional medical information is available from the Centers for Disease Control and Prevention.
Omphalocele and Gastroschisis Are Different
Omphalocele and gastroschisis are both abdominal-wall defects, but they have important differences:
- Location: An omphalocele extends through the central umbilical opening. Gastroschisis usually occurs beside the belly button, commonly on the right.
- Protective covering: Organs within an omphalocele are generally covered by a membrane. With gastroschisis, the organs are exposed directly to amniotic fluid.
- Associated conditions: Omphalocele is more frequently associated with chromosomal, genetic, cardiac, and other congenital abnormalities.
- Effect on the intestine: The exposed bowel in gastroschisis may become significantly inflamed through contact with amniotic fluid. The omphalocele sac generally provides some protection unless it ruptures.
Distinguishing between the conditions is important because their associated risks, recommended evaluations, treatment, and prognosis may differ.
Small, Large, and Giant Omphaloceles
A small omphalocele may contain only a short section of intestine and may be repaired soon after birth. A larger defect can contain extensive intestine, liver, stomach, or other organs.
The term giant omphalocele is commonly used when a substantial portion of the liver is outside the abdomen or when the opening is particularly large. In these cases, the abdominal cavity may be too small to accept all the organs immediately without creating dangerous pressure.
Large defects may also be associated with reduced space for normal lung development and greater respiratory needs after delivery.
Other Conditions That May Occur with Omphalocele
Unlike many cases of gastroschisis, omphalocele commonly occurs with another congenital or genetic condition. Associated findings can include:
- Congenital heart defects
- Chromosomal abnormalities
- Genetic syndromes
- Neural-tube defects
- Kidney or urinary abnormalities
- Diaphragm abnormalities
- Differences involving the gastrointestinal tract
- Abnormal fetal growth
The presence of an omphalocele does not mean that the baby necessarily has another condition. It does, however, commonly lead to a detailed evaluation of the fetal anatomy, heart, chromosomes, and other organ systems.
Possible Causes and Risk Factors
The precise cause is unknown in most individual cases. Researchers continue to investigate the interaction of genetic, maternal, developmental, and environmental factors.
The CDC identifies several factors associated with an increased probability of omphalocele:
- Alcohol use or heavy tobacco use before or during pregnancy
- Pre-pregnancy obesity
- Use of selective serotonin-reuptake inhibitor medications during pregnancy
These are statistical associations and not proof of individual causation. The presence of one factor does not establish that it produced the condition, that the condition could have been prevented, or that a healthcare provider was negligent.
SSRIs and Medication Use During Pregnancy
Selective serotonin-reuptake inhibitors, commonly called SSRIs, are used to treat depression, anxiety, and other medical conditions. Research cited by the CDC has reported an association between SSRI exposure during pregnancy and omphalocele, but an association does not demonstrate that a particular medication caused a particular child’s condition.
Untreated depression and other maternal conditions can also create serious risks. A prescribing decision therefore requires an individualized assessment of benefits, alternatives, and potential maternal and fetal risks.
A medication-related legal review may consider:
- The exact medication and dosage
- The condition being treated
- The timing and duration of use
- The risks of leaving the maternal condition untreated
- Reasonably available treatment alternatives
- The medical evidence and warnings available at that time
- The counseling and monitoring provided
- Whether reliable expert evidence supports individual causation
Medication exposure does not automatically establish negligent prescribing. A pregnant patient should not stop a prescribed medication without first discussing the risks and alternatives with an appropriate healthcare provider.
Information about preventable prescribing or dispensing mistakes is available on our medication and prescription error page.
Prenatal Screening and Diagnosis
Many omphaloceles are identified before birth through prenatal ultrasound. The condition may also be associated with an abnormal maternal blood or serum-screening result.
Because the intestines normally extend temporarily into the umbilical cord during very early development, an apparent abdominal-wall finding must be evaluated in light of gestational age. Persistent herniation after the intestines should have returned to the abdomen may support the diagnosis.
When an omphalocele is suspected, additional evaluation may include:
- A detailed fetal-anatomy ultrasound
- Repeat imaging by a maternal-fetal medicine specialist
- Evaluation of the organs contained within the sac
- Assessment of fetal growth and amniotic-fluid levels
- Detailed examination of the fetal heart
- Genetic counseling
- Screening or diagnostic chromosome testing
- Evaluation for other structural abnormalities
Prenatal screening and diagnostic testing provide different information. A screening result can estimate risk, while diagnostic procedures such as chorionic villus sampling or amniocentesis can provide more definitive chromosome information. The benefits, limitations, timing, and risks should be explained before testing decisions are made.
A Missed Prenatal Diagnosis Does Not Automatically Establish Malpractice
Failure to identify an omphalocele during a particular ultrasound does not automatically prove that the examination was negligent. A proper review must consider:
- The gestational age at the time of the study
- The baby’s position
- The size and appearance of the defect
- The quality and completeness of the images
- The views required during that examination
- The provider’s role in obtaining and interpreting the study
- Whether another abnormal finding should have led to follow-up testing
Earlier diagnosis does not remove or repair the abdominal-wall defect. It may, however, provide time for genetic evaluation, counseling, consultation with pediatric specialists, delivery planning, and immediate access to neonatal and surgical care.
Potential imaging concerns may overlap with a prenatal radiology error or broader diagnostic-error claim.
Delivery Planning
When the diagnosis is known before birth, the healthcare team can plan for delivery at a medical center with a neonatal intensive-care unit and pediatric surgical services.
The plan may involve obstetrics, maternal-fetal medicine, neonatology, pediatric surgery, anesthesia, cardiology, genetics, and other specialists. Relevant considerations include:
- The size of the omphalocele
- Whether the liver or other large organs are involved
- The condition of the protective sac
- Fetal growth and monitoring
- Associated heart, lung, genetic, or other conditions
- The safest timing and method of delivery
- The availability of immediate neonatal and surgical treatment
A cesarean delivery is not automatically required for every omphalocele. The appropriate method should be selected according to the defect’s anatomy, obstetric circumstances, and the recommendations of the treating specialists.
Immediate Care After Birth
After delivery, protecting the sac and stabilizing the newborn are immediate priorities. Medical care may include:
- Covering the sac with sterile protective material
- Avoiding pressure, rupture, or trauma to the exposed organs
- Maintaining body temperature
- Providing intravenous fluids and nutrition
- Using a tube to decompress the stomach
- Administering antibiotics when appropriate
- Providing respiratory support
- Evaluating circulation to the contained organs
- Prompt consultation with pediatric surgery
If the membrane breaks, the organs lose part of their natural protection and the risk of infection, fluid loss, and tissue injury can increase.
Surgical Treatment
The objective of treatment is to protect the organs, return them safely to the abdominal cavity, and close the abdominal-wall opening. The process must avoid creating excessive pressure on the lungs, heart, kidneys, intestines, and blood vessels.
Primary Repair
A small omphalocele may be repaired during one operation. The surgeon examines the organs, places them inside the abdomen, and closes the opening when sufficient space is available.
Staged Repair
When the abdominal cavity cannot safely contain all the organs immediately, a sterile pouch or silo may be used. The organs are moved into the abdomen gradually before the wall is closed.
This staged approach can reduce the risk of dangerous pressure that interferes with breathing, circulation, or organ function.
Delayed Closure for a Giant Omphalocele
In selected very large cases, immediate closure may not be safe. The sac can be protected while tissue gradually covers it. Reconstruction of the abdominal wall may then occur later, after the child has grown and the abdominal cavity can better accommodate the organs.
Possible Complications and Long-Term Needs
Possible complications include:
- Rupture of the protective sac
- Infection
- Reduced blood flow to an organ
- Injury caused by twisting or compression
- Breathing difficulty
- Underdeveloped lungs in some large cases
- Feeding intolerance or reflux
- Prolonged need for intravenous nutrition
- Bowel obstruction
- Abdominal-wall or groin hernia
- Need for additional surgery
- Medical issues caused by associated congenital or genetic conditions
The long-term outlook depends substantially on the size of the omphalocele, the health of the contained organs, lung development, surgical recovery, and the presence of other conditions.
Most Omphalocele Cases Do Not Involve Medical Malpractice
A healthcare provider generally does not cause an omphalocele simply because the condition developed during pregnancy. A potential claim ordinarily requires a separate and identifiable failure to meet the applicable standard of care and evidence that the failure caused legally recognized harm.
When Could Medical Negligence Be Relevant?
Prenatal Imaging, Testing, or Communication Errors
A legal review may be appropriate when:
- A significant abdominal-wall defect visible on prenatal imaging was overlooked
- The size or contents of the omphalocele were interpreted incorrectly
- An abnormal serum-screening result was not investigated
- Recommended follow-up imaging was not arranged
- A significant finding was not communicated to the patient or another provider
- Genetic counseling or indicated diagnostic testing was not discussed
- A referral to maternal-fetal medicine or pediatric surgery was unreasonably delayed
In limited circumstances, negligent testing, counseling, or communication may also raise issues addressed on our wrongful birth page. Such a claim does not ordinarily allege that the provider caused the omphalocele.
Failure to Investigate Associated Conditions
Because omphalocele frequently occurs with cardiac, chromosomal, genetic, and other abnormalities, a legal review may examine whether significant associated findings were investigated and communicated appropriately.
The presence of another condition does not itself prove negligence. The question is whether additional testing or specialist evaluation was medically indicated and whether a failure caused additional harm or deprived the family of important information.
Inadequate Delivery Planning or Newborn Care
Potential concerns may include:
- Failure to plan delivery at an appropriately equipped hospital when transfer was reasonably possible
- Failure to arrange necessary neonatal or pediatric surgical care
- Trauma to the sac during delivery or initial handling
- Failure to protect the organs after birth
- Failure to provide adequate fluids, temperature control, respiratory support, or infection prevention
- Unreasonable delay in treating a ruptured sac or impaired organ circulation
Negligent Surgery or Postoperative Care
Omphalocele repair carries serious risks even when performed appropriately. A poor result or known complication does not automatically establish malpractice.
A legal issue may exist, however, when preventable additional harm results from:
- Inadequate surgical planning
- Attempting closure despite unsafe abdominal pressure
- Injury to viable intestine, liver, blood vessels, or another organ
- A preventable surgical error
- An anesthesia, medication, or monitoring mistake
- Failure to recognize infection, organ ischemia, respiratory compromise, obstruction, or wound breakdown
- Inadequate nutritional, surgical, or long-term follow-up
Records Used to Evaluate a Potential Case
A medical and legal review may require:
- Prenatal and obstetric records
- Pregnancy-dating information
- Maternal serum-screening results
- Ultrasound reports and original images
- Maternal-fetal medicine consultations
- Fetal cardiac and genetic evaluations
- Medication and pharmacy records
- Delivery-planning and transfer records
- Fetal-monitoring and delivery records
- Newborn and neonatal intensive-care records
- Pediatric surgery and anesthesia reports
- Respiratory, feeding, laboratory, and nutritional records
- Postoperative and long-term follow-up documentation
Qualified medical experts may need to distinguish the effects of the congenital defect and associated conditions from any additional injury allegedly caused by delayed diagnosis, inadequate planning, or negligent treatment.
Contact Sexner Injury Lawyers LLC
Most children born with an omphalocele do not have a medical malpractice claim. A legal evaluation may be appropriate when there is a specific concern involving prenatal imaging, communication of results, genetic evaluation, medication management, delivery planning, newborn care, surgery, or postoperative treatment.
Contact Sexner Injury Lawyers LLC or call (312) 243-9922 for a free and confidential evaluation. We will explain honestly whether the circumstances appear to justify further investigation.
