Experience of 300 Cases of Prenatal Fetoscopic Open Spina Bifida Repair: Report of the International Fetoscopic Neural Tube Defect Repair Consortium

Cortes, M. Sanz; Chmait, R.H.; Lapa, D.A.; Belfort, M.A.; Carreras, E.; Miller, J.L.; Samaha, R. Brawura Biskupski; Gonzalez, G. Sepulveda; Gielchinsky, Y.; Yamamoto, M.; Persico, N.; Santorum, M.; Otaño, L.; Nicolaou, E.; Yinon, Y.; Faig-Leite, F.; Brandt, R.; Whitehead, W.; Maiz, N.; Baschat, A.; Kosinski, P.; Nieto-Sanjuanero, A.; Chu, J.; Kershenovich, A.; Nicolaides, K.H.

doi:10.1097/01.aoa.0000853588.45095.88

Cited by 7 publications

(8 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prenatal SBA repair has become widely adopted in the last decade after the positive outcome of the MOMS trial 14,33 . While a number of surgical techniques have been adopted and results are difficult to compare, it is believed that watertightness of fetal SBA layered repair is critical for good neurological outcome 39–41 . In this study, we have demonstrated in a validated lamb model that watertight layered fetal SBA repair is neuroprotective, as evidenced by 100% reversal of hindbrain herniation, low CSF leakage at the repair site, better hindlimb motor function, higher neuronal density in the hippocampus and corpus callosum and a larger area of reactive astrocytes at the lesion epicenter compared with in unrepaired lambs.…”

Section: Discussionmentioning

confidence: 99%

Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model

Joyeux

Merwe

Aertsen

et al. 2023

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model

Joyeux

Merwe

Aertsen

et al. 2023

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…Additionally, fetoscopic approaches reported higher rates of placental abruption, preterm premature rupture of membranes, and premature birth [26][27][28] compared to open techniques [8,[29][30][31][32]. Interestingly, vaginal birth rates after fetoscopic fetal SB repair differed from 0% [26,27] up to 30-60% [28,[33][34][35]. Regarding subsequent pregnancies after fetoscopic SB repair, Sanz Cortes et al [36] reported 10 subsequent pregnancies in a cohort of 73 women.…”

Section: Discussionmentioning

confidence: 99%

Subsequent Pregnancy Outcomes after Open in utero Spina Bifida Repair

et al. 2022

View full text Add to dashboard Cite

Introduction: Fetal spina bifida (SB) repair is a distinct therapeutic option in selected cases. Since this procedure may not only be associated with short-term obstetrical complications, the aim of this study was to assess the outcomes of subsequent pregnancies after open fetal SB repair. Methods: 138 patients having had open fetal SB repair at our center received a questionnaire regarding the occurrence, course and outcome of subsequent pregnancies. Additionally, medical records were reviewed. All subsequent pregnancies with complete outcome data that progressed beyond 20 gestational weeks (GW) were included for further analysis. Results: 70% of all women answered the questionnaire. Out of this cohort, 35 subsequent pregnancies were reported in 29% of women. The rate of early pregnancy loss including elective terminations was 14%. All 29 pregnancies processing > 20 GW ended in live births without preterm births < 34th GW. Mean gestational age at delivery was 37.3 ± 1.4 GW. Uterine rupture occurred in two cases (7%) and uterine thinning/dehiscence was present in six cases (21%). No maternal transfusions were required. Conclusion: When counseling women undergoing open fetal SB repair, one should consider possible risks for subsequent pregnancies, especially the one of uterine dehiscence and rupture that is similar compared to numbers reported after classical cesarean deliveries.

show abstract

“…Compared with the published results of percutaneous surgery, laparotomy-assisted fetoscopic repair [10, 18] appears to be associated with longer interval between surgery and delivery, lower PROM rate, and higher vaginal delivery rate, with a higher mean gestational age at delivery [12, 19]. An international registry of 300 children reported similar perinatal and neurosurgical outcomes in the first 12 months of life of children undergoing prenatal fetoscopic SBA repair compared to open surgery [20]. A recent publication reporting 16 cases describes similar outcomes to the ones we report hereby [21].…”

Section: Discussionmentioning

confidence: 99%

Laparotomy-Assisted 2-Port Fetoscopic Repair of Spina Bifida Aperta: Report of a Single-Center Experience in Paris, France

et al. 2022

View full text Add to dashboard Cite

Background: Given the maternal morbidity of open fetal surgery, the development of prenatal fetoscopic repair for spina bifida aperta (SBA) is encouraged. Objective: We hereby report the early results from our center, using a laparotomy-assisted CO2-fetoscopic approach. Methods: This study was conducted in patients with an SBA<T1 and >S1, <26 weeks’ of gestation, with Chiari II. Fetoscopic repair was performed using 2 operating trocars in the uterus exteriorized through a transverse laparotomy. Endoscopy was performed under humidified and heated CO2 insufflation. Following dissection of the lesion, a 1-layer approach was performed with a muscle/skin flap sutured over a patch of Duragen. Main outcomes were watertight repair at birth and the need for postnatal neurosurgical surgery including shunting within 6 months. Results: Of 87 women assessed for prenatal therapy, 7 were included. Surgery was performed at 24 (23-26) weeks’ gestation. There was no fetal demise. Conversion to hysterotomy was not performed, although surgery could not be performed in one case because of fetal position. Severe preeclampsia developed postoperatively in one case. In the other 6 cases, follow-up was uneventful except for premature rupture membranes which occurred in 3/6 cases at 30, 34 and 36+5-weeks’ gestation. Gestational age at delivery was 32+5 (31-36+5) weeks’ gestation. Repair was watertight at birth except in two cases which required complementary postnatal surgical repair. Reverse hindbrain herniation during pregnancy was observed in 4/6 cases. In 3/6 cases, shunting was necessary within six months after birth. At 12 months, a functional gain >= 2 metameric levels, was observed in 3 cases of the 6 survivors Conclusion: Laparotomy-assisted fetoscopic repair is a reasonable option for women who choose and are eligible for antenatal surgery, both in terms of maternal and perinatal morbidity.

show abstract

Experience of 300 Cases of Prenatal Fetoscopic Open Spina Bifida Repair: Report of the International Fetoscopic Neural Tube Defect Repair Consortium

Cited by 7 publications

References 2 publications

Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model

Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model

Subsequent Pregnancy Outcomes after Open in utero Spina Bifida Repair

Laparotomy-Assisted 2-Port Fetoscopic Repair of Spina Bifida Aperta: Report of a Single-Center Experience in Paris, France

Contact Info

Product

Resources

About