Background
The multicenter randomized controlled trial Management of Myelomeningocele Study demonstrated
that prenatal repair of open spina bifida by hysterotomy, compared with postnatal
repair, decreases the need for ventriculoperitoneal shunting and increases the chances
of independent ambulation. However, the hysterotomy approach is associated with risks
that are inherent to the uterine incision. Fetal surgeons from around the world embarked
on fetoscopic open spina bifida repair aiming to reduce maternal and fetal/neonatal
risks while preserving the neurologic benefits of in utero surgery to the child.
Objective
This study aimed to report the main obstetrical, perinatal, and neurosurgical outcomes
in the first 12 months of life of children undergoing prenatal fetoscopic repair of
open spina bifida included in an international registry and to compare these with
the results reported in the Management of Myelomeningocele Study and in a subsequent
large cohort of patients who received an open fetal surgery repair.
Study Design
All known centers performing fetoscopic spina bifida repair were contacted and invited
to participate in a Fetoscopic Myelomeningocele Repair Consortium and enroll their
patients in a registry. Patient data entered into this fetoscopic registry were analyzed
for this report. Fisher exact test was performed for comparison of categorical variables
in the registry with both the Management of Myelomeningocele Study and a post–Management
of Myelomeningocele Study cohort. Binary logistic regression analyses were used to
assess the registry data for predictors of preterm birth at <30 weeks’ gestation,
preterm premature rupture of membranes, and need for postnatal cerebrospinal fluid
diversion in the fetoscopic registry.
Results
There were 300 patients in the fetoscopic registry, 78 in the Management of Myelomeningocele
Study, and 100 in the post–Management of Myelomeningocele Study cohort. The 3 data
sets showed similar anatomic levels of the spinal lesion, mean gestational age at
delivery, distribution of motor function compared with upper anatomic level of the
lesion in the neonates, and perinatal death. In the Management of Myelomeningocele
Study (26.16±1.6 weeks) and post–Management of Myelomeningocele Study cohort (23.3
[20.2–25.6] weeks), compared with the fetoscopic registry group (23.6±1.4 weeks),
the gestational age at surgery was lower (comparing fetoscopic repair group with the
Management of Myelomeningocele Study; P<.01). After open fetal surgery, all patients were delivered by cesarean delivery,
whereas in the fetoscopic registry approximately one-third were delivered vaginally
(P<.01). At cesarean delivery, areas of dehiscence or thinning in the scar were observed
in 34% of cases in the Management of Myelomeningocele Study, in 49% in the post–Management
of Myelomeningocele Study cohort, and in 0% in the fetoscopic registry (P<.01 for both comparisons). At 12 months of age, there was no significant difference
in the number of patients requiring treatment for hydrocephalus between those in the
fetoscopic registry and the Management of Myelomeningocele Study.
Conclusion
Prenatal and postnatal outcomes up to 12 months of age after prenatal fetoscopic and
open fetal surgery repair of open spina bifida are similar. Fetoscopic repair allows
for having a vaginal delivery and eliminates the risk of uterine scar dehiscence,
therefore protecting subsequent pregnancies of unnecessary maternal and fetal risks.
Key words
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Article info
Publication history
Published online: June 02, 2021
Accepted:
May 28,
2021
Received in revised form:
May 28,
2021
Received:
December 28,
2020
Footnotes
The authors report no conflict of interest.
This study was supported by grants from the Fetal Medicine Foundation (charity number 1037116). This body had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Cite this article as: Sanz Cortes M, Chmait RH, Lapa DA, et al. Experience of 300 cases of prenatal fetoscopic open spina bifida repair: report of the International Fetoscopic Neural Tube Defect Repair Consortium. Am J Obstet Gynecol 2021;225:678.e1-11.
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