Maternal and fetal complications following fetal myelomeningocele repair – the first 100 cases

Introduction:

Despite the unequivocal benefits of open fetal myelomeningocele (fMMC) repair, this intervention remains associated with maternal and fetal risks. The advantages of a systematic classification of the maternal risks after fMMC repair according to a therapy-oriented classification of surgical complications by Clavien-Dindo have been shown earlier. The aim of this study was to systematically categorize the first 100 cases operated at the Zurich Center for Fetal Diagnosis and Therapy applying the above mentioned system for both, the mother and the fetus.

Patients and Methods:

Between 2010 and 2018, 100 patients underwent fMMC repair at the Zurich Center for Fetal Diagnosis and Therapy. We prospectively collected and analyzed all maternal and fetal complications following fMMC repair according to the Clavien-Dindo classification (Grad 1 = minor complications not requiring any treatment, Grad 2 = complication requiring pharmacological treatment, Grad 3 = complications requiring surgical intervention, Grad 4 = life-threatening complication requiring IC/ICU management, Grad 5 = death). For additional quality control, this data were compared to the results of the „MOMS-Trial“.

Results:

Gestational age (GA) at surgery and birth were 25.0+/-0.8 weeks and 35.5+/-2.0 weeks, respectively. Birthweight was 2587+/-479 g. No maternal complications occurred in 21% of the cases. Maternal complications were observed as followed (overall/operation related): Grad I 60%/48%, Grad II 44%/34%, Grad III 26%/13%, Grad IV 8%/6%, Grad V 0%. In 33% premature rupture of membranes were noted. A chorioamniotic membrane separation occurred in 17%, pulmonary edema in 2%, blood transfusion in 0%, placental abruption in 9% and uterine rupture in 1%. Additionally, 3% of pulmonary embolism were observed. As for fetal complications, there was one intrauterine resecuscitation with consecutive delivery directly after the fMMC repair due to a placental abruption, 1% of severe preterm birth < 30. weeks, 29% between weeks 30 – 34, and 35% late preterm births after 34. weeks.

Conclusion:

This study refreshes the consciousness of complications following open fMMC repair by showing serious maternal complications in 8% of all cases. The hereby-applied systematic classification of complications allows a tide quality control and blazes the trail for further management improvement as well as for comparisons between different centers.