Subsequent Pregnancy Outcomes after Open in utero Spina Bifida Repair

Abstract

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.

Subsequent fertility, pregnancy, and gynaecological and psychological outcomes after maternal–fetal surgery for open spina bifida: A prospective cohort study

“…Onset of problems with menstrual bleeding after index delivery (months) fertilisation for time (8%, n = 1/13). This is in line with the findings of Zepf et al, 10 only two out of 29 subsequent pregnancies necessitating in vitro fertilisation (6.9%).…”

“…The cohort fetal surgery studies mentioned above report similar rupture rates (7%-14%). [8][9][10]25 In our cohort, one mother (10%) had a prelabour uterine rupture of the fundal scar in the second pregnancy after fetal surgery. Remarkably, this was beyond the gestational age of 37 weeks at which a caesarean is recommended.…”

“…This is a higher rate than that found in the cohorts of Goodnight et al, Wilson et al and Zepf et al, who each reported a single case (2%-3%). [8][9][10] We certainly find it advisable to screen for abnormal placentation following open maternal-fetal surgery.…”

“…9 Zepf et al reported uterine rupture in 7%, with none followed by fetal or neonatal death, and with dehiscence reported in 21% of 29 women. 10 Therefore, little is known about the potential fertility and gynaecological problems in women undergoing this type of surgery. Furthermore, taking care of a child with spina bifida has an important psychological impact on parents, 11,12 to which fetal surgery may add.…”

“…Zepf et al. reported uterine rupture in 7%, with none followed by fetal or neonatal death, and with dehiscence reported in 21% of 29 women 10 . Therefore, little is known about the potential fertility and gynaecological problems in women undergoing this type of surgery.…”