Reproductive outcomes after fetal myelomeningocele repair

Background Fetal myelomeningocele (fMMC) repair is an accepted therapeutic procedure in fetal surgery centres around the world as it decreases neonatal morbidity associated with spina bifida. However, there is limited data available on the impact of this open procedure on future fertility.

Objective The objective of this study was to evaluate pregnancy outcomes in pregnancies followed by fMMC repair.

Study Design A detailed patient registry from the Clinic of Obstetrics, University Hospital Zürich was used to trace and report outcomes in pregnancies followed by the first 100 fMMC repairs performed from 2010-2018. Additionally, a standardised questionnaire was sent to all women. The study was approved by the Ethical committee of the University of Zürich.

Results Ten subsequent pregnancies were reported in 8 women. All conceptions were natural. The mean inter-pregnancy interval was 29.5+/-14.5 months. There was 1 first trimester loss. All other 9 pregnancies were delivered via caesarean section after 35 weeks of gestation (GW) with a mean gestational age of 37.6+/-1.6 GW and a live-birth rate of 100%. One woman with a multiple gestation in the subsequent pregnancy, that was followed at an external institution, developed uterine rupture at 35.1 GW. The rate of thinning of the uterine uterine scar was 33%. No major maternal or neonatal complications were reported.

Conclusion These preliminary results show that although open fetal surgery carries considerable risk of uterine rupture or scar thinning in the subsequent pregnancy, live birth rates in pregnancies following fMMC repair are comparable to that of the general population.

Publication History

Article published online:
07 October 2020