Fetoscopic two‐layer closure of open neural tube defects

Giné, C; Arévalo, Sílvia; Maíz, Nerea; Rodó, Carlota; Manrique, Susana; Poca, María A.; Molino, Jose Andrés; Carreras, Elena; López, María Cristina Lorente

doi:10.1002/uog.19104

Cited by 28 publications

(26 citation statements)

References 11 publications

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“…The incidence of CAS in our open‐hysterotomy group is the same as the 26% rate reported in the MOMS trial 3 , and consistently lower than that reported after fetoscopic repair 5,7,20 . We observed a 40% rate of CAS after fetoscopic repair, consistent with the 40% rate that Pedreira et al 20 .…”

Section: Discussionsupporting

confidence: 90%

Chorioamniotic membrane separation following fetal myelomeningocele repair: incidence, risk factors and impact on perinatal outcome

Corroënne

Yepez

Barth

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives Prenatal myelomeningocele (MMC) repair has been shown to provide significant benefits to the infant, decreasing the postnatal need for ventriculoperitoneal shunt and improving motor outcome. Chorioamniotic membrane separation (CAS) is a potential complication following prenatal MMC repair and may increase the risk of preterm prelabor rupture of membranes (PPROM) and preterm birth. The objectives of this study were: (1) to evaluate the incidence of CAS after prenatal MMC repair; (2) to determine risk factors associated with its occurrence; and (3) to assess its association with adverse perinatal outcomes. Methods This was a retrospective cohort study of patients who underwent fetal MMC repair between November 2011 and December 2018. Surgery was performed using either a fetoscopic (laparotomy or exteriorized uterus) approach or an open‐hysterotomy approach. Eligibility criteria were those reported in the Management of Myelomeningocele Study. If CAS was detected on ultrasound (US), its severity was graded as ‘mild’ if amnion detachment involved < 25% of the uterine cavity, ‘moderate’ if it involved 25–50% and ‘severe’ if it involved > 50%. Evolution of CAS was classified as stable, increasing or decreasing based on the difference in severity grading between the time at first diagnosis and the last US scan before delivery. Logistic regression analysis was performed to identify pre‐ or perisurgical factors associated with the development of CAS and to determine the risk of adverse perinatal outcome associated with CAS. Results In total, 91 cases were included. Fetoscopic or open‐hysterotomy repair of MMC was performed in 52/91 (57.1%) and 39/91 (42.9%) cases, at a median gestational age (GA) of 25.0 weeks (range, 22.9–26.0 weeks) and 25.0 weeks (range, 21.3–25.9 weeks), respectively. CAS was diagnosed in 31/91 (34.1%) patients, at a median GA of 28.1 weeks (range, 24.4–37.6 weeks). Anterior placenta was identified as a risk factor for the postoperative development of CAS (odds ratio (OR), 3.72 (95% CI, 1.46–9.5); P < 0.01). This risk was dependent on the repair technique. An anterior placenta significantly increased the risk of CAS after fetoscopic repair (OR, 3.94 (95% CI, 1.14–13.6); P = 0.03) but not after open repair (OR, 2.8 (95% CI, 0.6–12.5); P = 0.16). There was no significant difference in the rate of CAS after fetoscopic repair (21/52 (40.4%)) vs open‐hysterotomy repair (10/39 (25.6%)) (P = 0.14), nor were there any differences in GA at diagnosis of CAS, interval between surgery and diagnosis, distribution of CAS severity or progression of CAS between the two groups. CAS increased the risk of PPROM (50% in those with vs 12% in those without CAS) (OR, 7.6 (95% CI, 2.5–21.9); P < 0.01) and preterm delivery (70% vs 38%) (OR, 3.2 (95% CI, 1.3–8.1); P < 0.01). Fetoscopically repaired cases with CAS had a higher rate of PPROM (12/20 (60.0%) vs 2/31 (6.5%); P < 0.01) and preterm delivery (13/20 (65.0%) vs 5/31 (16.1%); P < 0.01) than those that did not develop CAS, while the differences were not...

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Section: Discussionsupporting

confidence: 90%

Chorioamniotic membrane separation following fetal myelomeningocele repair: incidence, risk factors and impact on perinatal outcome

Corroënne

Yepez

Barth

et al. 2020

Ultrasound in Obstet & Gyne

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“…Our findings might raise a discussion about the techniques available for fetal OSD repair. Currently, there are variations of the open (classical/mini‐hysterotomy) and endoscopic approaches (percutaneous/exposed uterus) . Perhaps an early surgery, namely, a surgery at closer to 20 weeks' gestation, would not be most feasible through a classical hysterotomy or using endoscopic access (considering the sizes of the staplers and available endoscopy instruments).…”

Section: Discussionmentioning

confidence: 99%

“…However, because the maternal and fetal complications following any kind of fetal surgery are not negligible, other approaches for fetal OSD correction have been proposed to reduce surgical invasiveness and possibly improving neuroprotection. Some research groups have tested modifications to the classical hysterotomy procedure and different endoscopic approaches, with promising results; all are still subject to further scientific validation.…”

Section: Introductionmentioning

confidence: 99%

Fetal open spinal dysraphism repair through a mini‐hysterotomy: Influence of gestational age at surgery on the perinatal outcomes and postnatal shunt rates

et al. 2020

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Objective: To analyze the impact of gestational age (GA) at the time of fetal open spinal dysraphism (OSD) repair through a mini-hysterotomy on the perinatal outcomes and the infants' ventriculoperitoneal shunt rates.Methods: Retrospective study of cases of fetal OSD correction performed from 2014 and 2019.Results: One hundred and ninety women underwent fetal surgery for OSD through a mini-hysterotomy, and 176 (176/190:92.6%) have since delivered. Fetal OSD correction performed earlier in the gestational period, ranging from 19.7 to 26.9 weeks, was associated with lower rates of postnatal ventriculoperitoneal shunting (P: .049).Earlier fetal surgeries were associated with shorter surgical times (P: .01), smaller hysterotomy lengths (P < .001), higher frequencies of hindbrain herniation reversal (P: .003), and longer latencies from surgery to delivery (P < .001). Median GA at delivery was 35.3 weeks. Multivariate binary logistic regression showed that both fetal lateral ventricle-to-hemisphere ratio (%; P < .001; OR: 1.14 [95% CI: 1.09-1.21]) and GA at the time of fetal surgery (P: .016; OR: 1.37 [95% CI: 1.07-1.77]) were independent predictors of postnatal ventriculoperitoneal shunting.Conclusion: Fetuses with OSD who were operated on earlier in the gestational interval, which ranged from 19.7 to 26.9 weeks, were less prone to receiving postnatal ventriculoperitoneal shunts.

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“…Minimally invasive approaches to repair fetal MMC have been implemented in different centers [7][8][9][10][11][12][13][14][15][16][17][18] to decrease obstetric and perinatal morbidity, while preserving the improved infant outcomes. In our experience, the main advantages of the exteriorized-uterus two-port fetoscopic approach 7 , used in our center, are the decreased incidence of maternal complications, the possibility of vaginal delivery 19 and a higher gestational age (GA) at birth than that seen when using the open-hysterotomy approach.…”

Section: Introductionmentioning

confidence: 99%

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Sanz‐Cortes

Torres

Yepez

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? Prenatal and postnatal brain microstructure is similar between infants who underwent open hysterotomy and those who had fetoscopic spina bifida repair, and changes seen over time were also comparable between the two groups. These findings support the safety of using CO 2 gas for uterine insufflation during fetoscopic spina bifida repair. What are the clinical implications of this work?The findings of this study add to the body of evidence supporting the use of CO 2 for uterine insufflation in fetoscopic myelomeningocele repair. Fetoscopic techniques are safer for the mother and the fetus than is open repair. As a shift in practice towards fetoscopic repair is expected, evidence for the safety of CO 2 use is of critical relevance. ABSTRACTObjective To compare prenatal and postnatal brain microstructure between infants that underwent fetoscopic myelomeningocele (MMC) repair and those that had open-hysterotomy repair. Methods This was a longitudinal retrospective cohort study of 57 fetuses that met the Management of Myelomeningocele Study (MOMS) trial criteria and underwent prenatal MMC repair, by a fetoscopic (n = 27) or open-hysterotomy (n = 30) approach, atResults There were no differences in GA at surgery or GA/postnatal age at MRI between the groups. No significant differences were observed in ADC values in any of the brain areas assessed between the open-repair and fetoscopic-repair groups at 6 weeks after surgery and in the first year after birth. No differences were detected in the ADC values of the studied areas between the control 88 Sanz Cortes et al. and prenatally repaired groups, except for significantly increased ADC values in the genu of the corpus callosum in the open-hysterotomy and fetoscopic-repair groups. Additionally, there were no differences between the two prenatally repaired groups in the percentage change in ADC values at any of the time intervals analyzed. ConclusionsFetoscopic MMC repair has no detectable effect on brain microstructure when compared to babies repaired using an open-hysterotomy technique. CO 2 insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects on fetal brain microstructure.

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Fetoscopic two‐layer closure of open neural tube defects

Cited by 28 publications

References 11 publications

Chorioamniotic membrane separation following fetal myelomeningocele repair: incidence, risk factors and impact on perinatal outcome

Chorioamniotic membrane separation following fetal myelomeningocele repair: incidence, risk factors and impact on perinatal outcome

Fetal open spinal dysraphism repair through a mini‐hysterotomy: Influence of gestational age at surgery on the perinatal outcomes and postnatal shunt rates

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

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