Risk factors for preterm birth following open fetal myelomeningocele repair – results from a prospective cohort

Abstract

BACKGROUND Fetal myelomeningocele (fMMC) repair is a therapeutic option in selected cases. This study aimed to identify risk factors for preterm birth (PTB) following open fMMC repair. METHODS Sixty-seven women underwent fMMC repair and delivered a baby between 2010 and 2018 at our center. Demographic, surgical, and pregnancy complications, including potential risk factors for PTB such as preterm premature rupture of membranes (PPROM), chorioamniotic membrane separation (CMS), and placental abruption were evaluated. RESULTS Maternal body mass index, maternal age, parity, previous uterine surgery, gestational age at fetal surgery, total surgery duration, surgical subcutaneous hematoma, oligohydramnios, and amniotic fluid leakage were not identified as risk factors for PTB. CMS (p = 0.028, 92 vs. 52%) and PPROM (p = 0.001, 95 vs. 52%) were highly associated with PTB. Placental abruption was found more often in women after fMMC repair than in a general obstetrical population (12 vs. 1%) and ended in premature birth in all cases (p = 0.024, 100 vs. 60%). However, the majority of women delivered at a gestational age >35 weeks. CONCLUSIONS In our study cohort, risk factors for PTB were PPROM, CMS, and placental abruption, whereas surgery duration did not influence outcome. We conclude that the surgery technique should aim to minimize CMS and amniotic fluid leakage.

Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique – A systematic review

“…Ultimately, we included seven articles for the final analysis of the data. 16,[21][22][23][24][25][26] The flowchart of included and excluded studies is shown in Figure 1. The characteristics of the included studies are in Table 1.…”

“…Among the seven studies selected for analysis, the cases reported by Hisaba et al, 21 Bennett et al, 22 Zamłyński et al, 23 Etchegaray et al, 24 Maike et al, 25 were operated under the standard or classical technique with a hysterotomy of (6-8 cm). The patients reported by Peralta et al 26 underwent the open technique but with a 3.5 cm incision.…”

“…Table 2 shows the bias analysis of the included studies. Three studies 21,25,26 showed an unclear risk in the inclusion criteria of the participants, whether or not it had consecutive inclusion of the same.…”

Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair – When Do These Signs Disappear and is Shunting Predictable?

“…Since fetal intervention is associated with significant investment [12] and certain risks for the mother and fetus [13,14], it seems crucial to identify factors indicating the risk of shunt placement during the infant's first year of life. We could show in a previous study that ventricle width plays an important predictive role for the necessity of shunt placement [15].…”

Stage 2: The Vaginal Flora in Women Undergoing Fetal Spina Bifida Repair and Its Potential Association with Preterm Rupture of Membranes and Preterm Birth

“…Large studies have shown that vaginal dysbiosis is associated with an increased risk for preterm prelabour rupture of membranes (PPROM) and preterm birth (PTB) [ 5 , 6 , 7 ]. After open fetal spina bifida (fSB) repair, PPROM and PTB occur in approximately 30–50% and 60–80% [ 8 , 9 , 10 ], however, no previous study has yet focused on the prevalence of vaginal dysbiosis and its association with PPROM and PTB in the fSB repair population. This study explores the incidence of normal and abnormal pre- and post-surgical vaginal flora and its possible association with PPROM and PTB in fSB patients.…”