Two step prenatal gastroschisis repair: A case report

Gastroschisis prevalence is increasing globally, currently estimated at 3–10 per 10,000 live births, with marked disparities in outcomes across regions. Although survival rates approach 95%, mortality continues to be substantial in low- and middle-income settings . We report the case of a female fetus with a prenatal diagnosis of gastroschisis at 17 weeks, without associated anomalies. Prenatal management followed a two-step protocol that included, first, Botulinum toxin type A (BTX-A) injection at 22 weeks, 40 units (diluted at 10 units per ml) were administered under ultrasound guidance into the transverse and internal oblique muscles of the left and right sides of the abdominal wall using a 21G needle with adequate fetal tolerance. Weekly ultrasound follow-up demonstrated a significant sequential increase in abdominal circumference. Subsequently, repair was performed at 26 weeks under fetal anesthesia, by three-port laparotomy-assisted fetoscopic approach with reduction of exteriorized bowel loops and abdominal wall closure using interrupted full-thickness 4-0 polyglactin sutures. Fetal heart rate was monitored every 10 minutes. The procedure ended with amniotic fluid restoration using warmed Ringer’s lactate with cefazolin and 30-minute umbilical cord monitoring. Weekly ultrasounds revealed noteworthy fetal growth catch-up. The newborn was delivered vaginally at 35 weeks without complications, initiated immediate breastfeeding, and was discharged on day nine of life. At five months of follow-up, no abnormalities were observed, with normal growth according to WHO reference charts. A two-step approach with BTX-A and fetoscopic repair appears to be a feasible option for the prenatal management of non-complicated gastroschisis.