Fetal surgery for spina bifida: results after 200 operations

Introduction Since the MOMS trial showed a clear benefit of open fetal Spina bifida (fSB) repair compared to postnatal surgery, fetal surgery became a valid option in selected cases. We present an update on maternal and fetal outcomes after 200 operations (OP).

Materials and methods Between 2010 and 2023, 200 cases were operated at out Center. Data of two cases were excluded due to withdrawn informed consent. Thus, 198 cases were included. Data was collected in a RedCap database. Maternal, fetal and neonatal outcomes as well as the key outcome parameters (ventricoloperitoneal shunt placement at 1 year, independent ambulation at 3 years and bladder control at 4 years of age) were evaluated.

Results Maternal age at OP was 31.5+/-5 years and their BMI 26+/-4.9 kg/m2. Gestational age (GA) at fSB repair was 25+/-0.8 weeks. Postoperatively, abdominal wall seroma/uterine hematoma was detected in 40%. Lung embolism was diagnosed in 1.5%. Amniotic fluid leakage through the hysterotomy was seen in 5% causing oligohydramnios. Chorioamniotic membrane separation was found in 12%, PPROM occurred in 30%. Placental abruption did occur in 8%. Intermittent fetal bradycardia was noted in 2% of the fetuses requiring intraoperative pharmacological and/or mechanical resuscitation. One postoperative fetal and perinatal death occurred due to fetal liver rupture and severe lung hypoplasia (1%). No maternal death occurred. GA at birth was 35.4+/-2.4 weeks, the birthweight 2553+/-535g, 5min Apgar 7+/-2 with normal umbilical artery-pH in all newborns (N=194). 30% of all children post fSB repair received a ventriculoperitoneal shunt placement during their first year of life (N=151). At 3 years, 84% walked independently (N=57). At 4 years, 16% had normal bladder control (N=42).

Conclusion Maternal, fetal and neonatal outcomes as well as the key outcome parameters are comparable to the results of the MOMS trial. Nevertheless, these results emphasize that fetal surgery remains associated with risks for mother and fetus and that fSB repair is not a cure. Appropriate prenatal counselling as well as rigorous management of these cases beyond fetal surgery seem essential to optimize the outcomes for mother and child.

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Artikel online veröffentlicht:
15. November 2023