Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

Abstract

Objective To establish maternal complication rates for fetoscopic or open fetal surgery. Methods We conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery, and after the index pregnancy. Results One hundred sixty‐six studies were included, reporting outcomes for open fetal (n = 1193 patients) and fetoscopic surgery (n = 9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI, 15.22‐27.13) for open fetal and 6.2% (95%CI, 4.93‐7.49) for fetoscopic surgery. For severe maternal complications (grades III to V Clavien‐Dindo classification of surgical complications), the risk was 4.5% (95% CI 3.24‐5.98) for open fetal and 1.7% (95% CI, 1.19‐2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n = 175, 23.3%) was excluded for failing to report the presence or absence of maternal complications. Conclusions Maternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures. Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies.

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2019

“…Fetal therapy contributes significantly to the literature, and this year we highlight maternal issues as well as technological developments that could enhance our ability to deliver in‐utero therapy. In 2019, two papers described the potential maternal complications of fetal surgery . The first was a systematic review of 166 studies reporting either open or endoscopic in‐utero surgery.…”

“…This showed that the risk for any maternal complication was higher (20.9%) for open fetal surgery compared to endoscopic surgery (6.2%). When considering only severe complications, the difference was smaller: 4.5% for open and 1.7% for endoscopic surgery . However, in this review, around a quarter of studies reviewed were excluded as they failed to comment on maternal outcomes.…”

“…In 2019, two papers described the potential maternal complications of fetal surgery. 36,37 The first was a systematic review of 166 studies reporting either open or endoscopic in-utero surgery. This showed that the risk for any maternal complication was higher (20.9%) for open fetal surgery compared to endoscopic surgery (6.2%).…”

“…When considering only severe complications, the difference was smaller: 4.5% for open and 1.7% for endoscopic surgery. 36 However, in this review, around a quarter of studies reviewed were excluded as they failed to comment on maternal outcomes. Of note, this review also showed that open fetal surgery increased the risk of preterm labour in subsequent pregnancies but not uterine dehiscence or rupture.…”

Fetal surgery for open spina bifida

“…A systematic review from our institution showed that, following open fetal surgery for spina bifida and other conditions, 48% of women had a subsequent pregnancy, with a preterm delivery rate of 20% and a uterine dehiscence/rupture rate of 7% and 11%, respectively.…”