Two-port, exteriorized uterus, fetoscopic meningomyelocele closure has fewer adverse neonatal outcomes than open hysterotomy closure

• Published in: American journal of obstetrics and gynecology 2021-09, Vol.225 (3), p.327.e1-327.e9
• Main Authors: Espinoza, Jimmy, Shamshirsaz, Alireza A., Sanz Cortes, Magdalena, Pammi, Mohan, Nassr, Ahmed A., Donepudi, Roopali, Whitehead, William E., Castillo, Jonathan, Johnson, Rebecca, Meshinchi, Nazli, Sun, Raphael, Krispin, Eyal, Corroenne, Romain, Lee, Timothy C., Keswani, Sundeep G., King, Alice, Belfort, Michael A.
• Format: Article
• Language: English
• Subjects: closure; exteriorized uterus; fetoscopic; meningomyelocele; neonatal; outcomes; two-port
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2021.04.252

In utero closure of meningomyelocele using an open hysterotomy approach is associated with preterm delivery and adverse neonatal outcomes. This study compared the neonatal outcomes in in utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach vs the conventional open hysterotomy approach. This retrospective cohort study included all consecutive patients who underwent in utero meningomyelocele closure using open hysterotomy (n=44) or a 2-port, exteriorized uterus, fetoscopic approach (n=46) at a single institution between 2012 and 2020. The 2-port, exteriorized uterus, fetoscopic closure was composed of the following 3 layers: a bovine collagen patch, a myofascial layer, and a skin. The frequency of respiratory distress syndrome and a composite of other adverse neonatal outcomes, including retinopathy of prematurity, periventricular leukomalacia, and perinatal death, were compared between the study groups. Regression analyses were performed to determine any association between the fetoscopic closure and adverse neonatal outcomes, adjusted for several confounders, including gestational age of