Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele

Published:March 15, 2019DOI:


      Open maternal-fetal surgery for fetal myelomeningocele results in reduction in neonatal morbidity related to spina bifida but may be associated with fetal, neonatal, and maternal complications in subsequent pregnancies.


      The objective of this study was to ascertain obstetric risk in subsequent pregnancies after open maternal-fetal surgery for fetal myelomeningocele closure.

      Study Design

      An international multicenter prospective observational registry created to track and report maternal, obstetric, fetal/neonatal, and subsequent pregnancy outcomes following open maternal-fetal surgery for fetal myelomeningocele was evaluated for subsequent pregnancy outcome variables. Institutional Review Board approval was obtained for the registry.


      From 693 cases of open maternal-fetal surgery for fetal myelomeningocele closure entered into the registry, 77 subsequent pregnancies in 60 women were identified. The overall live birth rate was 96.2%, with 52 pregnancies delivering beyond 20 weeks gestational age and median gestational age at delivery of 37 (36.3–37.1) weeks. The uterine rupture rate was 9.6% (n = 5), resulting in 2 fetal deaths. Maternal transfusion was required in 4 patients (7.7%).


      The risk of uterine rupture or dehiscence in subsequent pregnancies with associated fetal morbidity after open maternal-fetal surgery is significant, but is similar to that reported for subsequent pregnancies after classical cesarean deliveries. Future pregnancy considerations should be included in initial counseling for women contemplating open maternal-fetal surgery.

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      Linked Article

      • Uterine legacy of open maternal–fetal surgery: preterm uterine rupture
        American Journal of Obstetrics & GynecologyVol. 221Issue 5
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          We congratulate Goodnight et al1 on the publication of a study in the Journal in March of 2019 titled, “Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele.” Using an international multicenter prospective observational registry, the authors’ analysis of 52 subsequent pregnancies after open maternal–fetal surgery (OMFS) for fetal myelomeningocele revealed that the risk of uterine rupture was 9.6% (5/52) and the additional risk of uterine dehiscence/thinness was 17.3% (9/52).
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