<b><i>Introduction:</i></b> The main aim of the fetal surgery of myelomeningocele (MMC) is the improvement in prognosis for children with this defect and at the same time high safety of the procedure for mother and fetus. <b><i>Objective:</i></b> The aim of the study was to determine the effectiveness of alternative hysterotomy technique for fetal surgery of MMC in prevention of essential perinatal complications. <b><i>Methods:</i></b> Forty-nine pregnant women diagnosed with fetal MMC (fMMC) who underwent classic hysterotomy without the use of stapler formed the study cohort. Two cases of intrauterine fetal death or neonatal death in the immediate perioperative period in the study group (SG) were excluded from further analyses. In the historical control group (46 patients) from our center hysterotomy was performed according to Management of Myelomeningocele Study (MOMS) protocol. The study cohort’s outcomes were compared with the historical controls and with post-MOMS results in Children’s Hospital of Philadelphia (CHOP) and Vanderbilt University Medical Center (VUMC). <b><i>Results:</i></b> In the SG we did not observe delivery before 30 weeks of gestation (0/47; 0%) and the incidence of chorionamniotic membrane separation (CMS, 3/47; 6%) and preterm premature rupture of membranes (PPROM, 7/47; 15%) was lower compared to the other groups. Preterm delivery as a result of uterine contractions occurred significantly less frequently in the SG (8/47; 17%). Fetal surgery with classic hysterotomy resulted in rare use of magnesium sulfate (3/47; 6%). <b><i>Conclusions:</i></b> The alternative hysterotomy technique for fetal surgery of MMC results in low occurrences of CMS, PPROM, preterm delivery, and the rare use of tocolytics.

Myelomeningocele (MMC) constitutes the most common congenital defect of the central nervous system, with no satisfactory alternative to the postnatal treatment. Prenatal repair of MMC is aimed at protecting from a Chiari type II malformation. The main goal of fetal MMC repair is to improve the development and quality of life in children with a Chiari type II malformation. The Management of Myelomeningocele Study (MOMS), which was published in 2011, confirmed the effectiveness of prenatal surgery. In this paper, we compared the MOMS results with our own clinical experience. Owing to high effectiveness and significant improvement in the safety of the maternal-fetal surgery, prenatal MMC repair has become a new standard of treatment.

Pęknięcie pęcherza owodniowego pomiędzy 22 a 33 tygodniem ciąży (preterm premature rupture of membranes-PPROM) jest szczególnym scenariuszem klinicznym, kiedy losy noworodka są niepewne, ale jego przeżycie jest prawdopodobne. Celem pracy było przedstawienie pełnego spektrum problemów podczas diagnostyki i leczenia ciężarnej w tej szczególnie trudnej sytuacji.