Open fetal myelomeningocele repair at a university hospital: surgery and pregnancy outcomes

• Published in: Archives of gynecology and obstetrics 2021-12, Vol.304 (6), p.1443-1454
• Main Authors: da Rocha, Luana Sarmento Neves, Bunduki, Victor, de Amorim Filho, Antônio Gomes, Cardeal, Daniel Dante, Matushita, Hamilton, Fernandes, Hermann Santos, Nani, Fernando Souza, de Francisco, Rossana Pulcineli Vieira, de Carvalho, Mário Henrique Burlacchini
• Format: Article
• Language: English
• Subjects: Cross-Sectional Studies; Endocrinology; Female; Fetus - surgery; Fetuses; Gynecology; Hospitals; Human Genetics; Humans; Hydrocephalus - surgery; Infant, Newborn; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Meningomyelocele - surgery; Neural Tube Defects - surgery; Obstetrics/Perinatology/Midwifery; Pregnancy; Pregnancy Outcome; Prenatal Care; Spinal Dysraphism - surgery; Surgery; Surgical outcomes; Treatment Outcome
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-021-06066-y

Purpose Myelomeningocele (MMC) is an open neural tube defect that causes great morbidity. Prenatal open repair is the standard treatment; however, there are many complications related to the procedure. This study reports preliminary findings of open in utero repair of MMC in a public tertiary hospital in Brazil and describes factors that could be associated with increased surgical morbidity. Methods Thirty-nine patients underwent open in utero repair of MMC from October 2015 to August 2019. The Clavien–Dindo classification of surgical complications and a classification system with the preterm definitions of the World Health Organization were used, respectively, for maternal and fetal complications. Results A total of 28 mothers (71.8%) and 31 fetuses (79.5%) experienced at least one minor to major complication. Three mothers (7.7%) had a severe grade 4 complication. Fetal complications grades 3 to 5 occurred in 13 fetuses (33.3%). Gestational age at surgery and at birth were 24.88 ± 1.16 weeks and 33.23 ± 3.68 weeks, respectively. Preterm delivery occurred in 30 patients (76.9%), membrane rupture in 18 patients (46.2%) and chorioamnionitis in 13 patients (33.3%). Conclusion Open fetal surgery for MMC was performed at a Brazilian public tertiary care center, resulting in three grade 4 maternal complications. Relevant fetal complications were also present. The use of a standard classification system for complications renders studies more comparable and data more useful for counseling patients. Adjustments of perioperative procedures and long-term follow-up are needed to determine the real benefit of open in utero repair of MMC at our hospital.