Open fetal surgery for myelomeningocele — is there the learning curve at reduction mother and fetal morbidity?

Abstract

Objectives:We aimed to show how increased experience of a surgery team in fMMC repair influences maternal and fetal/neonatal outcomes. Material and methods:We compare perinatal results of fMMC repair in our Fetal Surgery Center (FSC) in cohort groups for the early period (2005)(2006)(2007)(2008)(2009)(2010)(2011) year; previous -PFSC, n = 46) and current period (2012)(2013)(2014)(2015) year; current -CFSC, n = 74) to results of the randomized Management of Myelomeningocele Study (MOMS, 78 patients). Results:The maternal morbidity due to fMMC repair was low and there was no difference comparing CFSC to PFSC and MOMS. The frequency of iatrogenic preterm labor (iPTL) ≤ 30 weeks of gestation decreased from 34.1% in PFSC to 23.9% in CFSC. Iatrogenic preterm premature rupture of membranes (iPPROM) was a common complication after fMMC repair in all cohorts. The total reduction rate of hindbrain hernation (HH) was similar in CFSC -90.3% and PFSC -82.1%. Conclusions:The increasing experience of our surgery team in fMMC repair majorly decreased the risk of iPTL.

Neonatal ten-year retrospective study on neural tube defects in a second level University Hospital

“…These unfavorable outcomes are still highly prevalent also in HICs [9,19]. Thus, despite the achievement of advanced standards of care and the improvements in neonatological management and surgical techniques [8,25,26], they have been observed also in some of our patients.…”

Anesthesia for fetal operative procedures: A systematic review

“…MFA was provided in 1,551 procedures from 59 studies ( 12 , 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , 83 , 85 , 86 , 88 , 95 , 98 , 100 , 104 , 106 , 108 , 112 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 172 , 176 , 177 ). Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 ,…”

“…MMC repair was described in 35 studies, totaling 1,372 patients. Open ( 16 , 20 , 24 , 28 , 40 , 46 , 54 , 73 , 85 , 86 , 91 , 113 , 115 , 120 , 121 , 127 , 137 , 154 , 156 , 158 , 166 , 172 , 176 , 177 ) and fetoscopic ( 17 – 19 , 28 , 29 , 33 , 99 , 134 , 140 , 171 , 178 ) repair were individually evaluated. One study was excluded due to cumulative data on both surgical approaches ( 41 ).…”

Alternative technique of intrauterine myelomeningocele repair to decrease the incidence of unfavorable maternal and fetal outcomes

“…The results of the multi-center, randomized study of the MOMS (Management of Myelomeningocele Study) group heralded a new era of treating OSB, with long-term observational studies confirming the effectiveness of this approach [2][3][4][5]. Worldwide, a steadily growing number of centers undertake the task of treating fetal myelomeningocele (fMMC), and their findings continue to demonstrate improved maternal and fetal safety in prenatal MMC repair [6][7][8][9][10][11].…”

“…Currently, multilayered closure of fMMC using open fetal surgery (OFS), being one of the available therapeutic options, remains the gold standard for treating that defect. The management, regardless of its undeniable benefits, is associated with a considerable risk for complications [3,[10][11][12], chief among them preterm labor (PTL) and the resulting prematurity, preterm premature rupture of membranes, (PPROM), as well as oligohydramnios or chorioamniotic separation (CAS) [3,[10][11][12]. Prenatal surgery is associated with maternal risk for pulmonary edema, hemorrhage which might require blood transfusion, and uterine scar dehiscence, including the risk of uterine rupture [12].…”