A study to assess knowledge and acceptability of foetal surgery for spina bifida amongst healthcare professionals in the UK

Sacco, Adalina; Ahmed, Shahanaz; Deprest, Jan; David, Anna L.

doi:10.1080/01443615.2019.1621820

Cited by 3 publications

(5 citation statements)

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“…In the first one Kunpalin and colleagues describe prognostic factors indicating the need for postnatal cerebrospinal fluid diversion after in‐utero repair of spina bifida 22 . Such papers are much needed as prenatal repair of open spina bifida is globally embraced, driven by the solid evidence for its fetal benefits, which are sustainable, and respond to patient demand 23,24 . The second paper reports Peralta and colleagues' early experience ( n = 10) of percutaneous endoscopic third ventriculostomy (ETV) in fetuses with isolated progressive and/or severe bilateral ventriculomegaly 25 .…”

Section: Figurementioning

confidence: 99%

“…22 Such papers are much needed as prenatal repair of open spina bifida is globally embraced, driven by the solid evidence for its fetal benefits, which are sustainable, and respond to patient demand. 23,24 The second paper reports Peralta and colleagues' early experience (n = 10) of percutaneous endoscopic third ventriculostomy (ETV) in fetuses with isolated progressive and/or severe bilateral ventriculomegaly. 25 This approach is being proposed as an alternative to shunt insertion to divert excess cerebrospinal fluid and reduce supratentorial intracranial hypertension.…”

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The new fetal therapy section awaits your research

Deprest,

Van Mieghem

2023

Prenatal Diagnosis

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The new fetal therapy section awaits your researchAlthough the journal title "Prenatal Diagnosis" may not suggest the interest of our readerships in fetal therapy, we have been satisfying their needs by publishing on medical and surgical fetal treatments since the 1980s. Our aims and scope actually call for authors to submit their "research on developing fetal therapy as well as the wider impact of fetal treatment." 1 Over the last 10 years, the number of papers published in this field across all journals has been growing steeply (Figure 1). This reflects the increasing number of treatment options but also an increased research interest, generating better evidence and stimulating its wider acceptance. Based on a PubMed search, Prenatal Diagnosis has followed that global publication trend, without diluting the quality, eventually capturing a steady share of around 3%-5% of fetal therapy publications, which we deemed relevant to our multidisciplinary readership. 14 With a growing numerator however, the denominator is also increasing. It is for that reason that the Editors have opted to formalize the interest of Prenatal Diagnosis in the field of fetal therapy, by creating a dedicated section of the journal to this growing discipline. Within this section we aim to cover the entire journey of a fetal intervention: from the concept of a new or alternative treatment to its long-term outcomes. This means that the journal is open to original research on the pathophysiology of conditions potentially amenable to fetal therapy (including preclinical models), as well as early clinical experience, including instrument and device development, drug studies, feasibility and safety studies, longer term outcome studies, research on the ethical and social issues associated with fetal therapy as well as documentation of maternal impact. (Re)consideration of (new) conditions for fetal intervention, or the introduction of novel therapies, typically renews interest in the conditions under study. It generates new research into the natural history of disorders as well as into more accurate diagnostic tools and prediction models, which in this day and age will often include the use of molecular tools, genetic profiling and artificial intelligence. Better imaging and prognostication will improve case selection-a conditio sine qua non for fetal therapy. With growing experience, the level of evidence for a given fetal intervention must eventually mature by conducting well-conceived and properly conducted clinical studies with sufficient numbers of participants. Ideally interventions are compared against the "gold-standard" in a randomized clinical trial.Despite logistic, financial and at times ethical concerns and prejudice from clinicians, [15][16][17][18] the fetal surgery community has shown it is possible to successfully complete such trials (Figure 1). These landmark papers justify the wider spread of the procedure, in turn generating new data and research opportunities. Although Prenatal

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The new fetal therapy section awaits your research

Deprest,

Van Mieghem

2023

Prenatal Diagnosis

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“…Both fetoscopic approaches would rank as innovative treatments, however based on the most recent series effectiveness could be scored as acceptable (Figure 1). 15,16,50 The following recommendations were suggested for interventions that fall in the innovative treatment category: (1) treatment should only be offered by expert centers; (2) there should be a commitment to closely monitor their practice conducting thorough follow-up studies with the purpose of publishing the (positive and negative) results in peer-reviewed journals; (3) patients should be adequately informed about all relevant aspects of the procedure (including surgical expertise) and about the status of the treatment (lack of long-term outcomes should be emphasized) and ( 4) centers should always be prepared to stop treatment when there are signs of serious concerns based on their own studies or on published reports. 49 This also implies that all patients should also be asked for their consent for any innovative treatment and also to be contacted in the future for follow-up studies.…”

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confidence: 99%

“…After its publication in 2011, the Management of Myelomeningocele study (MOMS) has led to a widespread expansion of centers offering prenatal surgery for fetuses with a spina bifida. 1 , 2 The benefits of prenatal surgery are a reduction in the need for ventriculo‐peritoneal (VP) shunt placement, as well as improved mental development, motor and urological outcomes. 1 , 3 The downside of open maternal‐fetal surgery is the high maternal morbidity and the risk of uterine rupture due to the large hysterotomy in current and subsequent pregnancies.…”

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confidence: 99%

Fetoscopic myelomeningocoele closure: Is the scientific evidence enough to challenge the gold standard for prenatal surgery?

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Since the completion of the Management of Myelomeningocoele Study, maternalfetal surgery for spina bifida has become a valid option for expecting parents.More recently, multiple groups are exploring a minimally invasive approach and recent outcomes have addressed many of the initial concerns with this approach.Based on a previously published framework, we attempt to delineate the developmental stage of the surgical techniques. Furthermore, we discuss the barriers of performing randomized controlled trials comparing two surgical interventions and suggest that data collection through registries is an alternative method to gather high-grade evidence. | INTRODUCTIONAfter its publication in 2011, the Management of Myelomeningocele study (MOMS) has led to a widespread expansion of centers offering prenatal surgery for fetuses with a spina bifida. 1,2 The benefits of prenatal surgery are a reduction in the need for ventriculo-peritoneal (VP) shunt placement, as well as improved mental development, motor and urological outcomes. 1,3 The downside of open maternalfetal surgery is the high maternal morbidity and the risk of uterine rupture due to the large hysterotomy in current and subsequentThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…Prenatal Diagnosis follows the changing role of MRI in fetal medicine closely . As the interest in, as well as the centers offering fetal therapy is growing, an increasing number of fetal medicine specialists and multidisciplinary fetal diagnosis and treatment teams will be confronted with and will use fetal MRI . For that reason, the editors at Prenatal Diagnosis thought the time was right to invite leading researchers in the fields of fetal MRI and fetal therapy to review the present and future applications of MRI for conditions amenable for fetal intervention.…”

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