Gastroschisis in monozygotic twins: A successful approach in a developing country

Abstract

Gastroschisis is a congenital birth defect of the abdominal wall, with a high mortality rate in middle-income countries, especially among twins. We report a monozygotic twin pregnancy in a 14-year-old girl with a low socioeconomic status and living in a rural area 4 hours away from our II-III health care level hospital, which has medical expertise for handling gastroschisis, in a developing country (Mexico). Prenatal screening was performed using ultrasonography and magnetic resonance imaging, followed by close monitoring and lung maturity induction. A caesarean section was scheduled at 36 weeks, with three available operating rooms for the mother, twin 1, and twin 2, with three teams of specialists. Birth management was done under sedation and analgesia, without intubation. Primary closure was performed for twin 1 and a preformed silo was used for twin 2, who had associated arthrogryposis. Both twins underwent defect sealing with hydrocolloid dressings and sutureless closures, and subsequent neonatal intensive care unit treatment. They had 46XY chromosomes and an identical genetic profile, and were discharged on days 23 and 49, respectively. A specialized multidisciplinary team with state-of-the-art technology, adapted to the hospital conditions of a middle-income country, is paramount for the positive outcomes of twins with gastroschisis.

Keywords

• Gastroschisis
• Twin gastroschisis
• Monozygotic twins
• Low-income country
• Middle-income country
• Caesarean section