Fetoscopic repair of open spina bifida in twin pregnancy. Case report

Abstract

Introduction. Open spina bifida (OSB) - neural tube formation defect, occurring in 1–7/1000 newborns, characterised by a tear in the spine due to the vertebral arches not forming properly. After birth, OSB manifests as leg muscle weakness or paralysis, gait, sensory, defecation, and urination problems. While fetal surgery for OSB is gaining popularity, its benefits versus harms in twin pregnancies are debatable. Case description. A 38-year-old woman (gravida 3, para 3) presented to Kaunas Clinics Hospital of Lithuanian University of Health Sciences with dichorionic diamniotic twins for a second trimester anomaly scan. Ultrasound scan revealed myelomeningocele in twin A’s lumbosacral region, beginning at L5 vertebra, measuring 15,7 x 16,3 mm. Twin B was not diagnosed with any pathology. Information on postnatal surgery and fetoscopic repair for twin A, along with potential complications, was provided. Nevertheless, the patient insisted on fetal surgery. Prof. Thomas Kohl from the German Centre for Fetal Surgery and Minimally Invasive Therapy performed the successful fetoscopic repair of OSB using biocellulose patch technique for twin A at 28.1 w. At 29.1 w. preterm premature rupture of membranes was diagnosed and RDS prophylaxis, tocolysis and antibiotic prophylaxis were given. At 29.3 w. contractions started and c-section was performed. IV antibiotics for postpartum infection were administered for 9 days. Twin A 1020 g, Apgar 7/8/10 and twin B 1140 g, Apgar 7/8/9 were born. Twin A had no need for a repair site revision or experienced cerebrospinal fluid leakage at birth. Conclusions. Fetal surgery, particularly in twin pregnancies, often leads to increased prematurity risk. Fetoscopic repair of open spina bifida using the biocellulose patch technique is feasible with an experienced team. Summary. This report highlights a rare case of managing open spina bifida in twin pregnancy through fetal surgery