Perinatal results of intrauterine open fetal surgery of fetuses diagnosed with myelomeningocoele – the clinical report of ten cases

Abstract

The purpose of the study was to demonstrate our approach to qualification for open fetal surgery (OFS) and surgery techniques. We also tried to determinate the outcome of fetal surgical treatment. OFS was performed in 10 out of 15 cases with prenataly diagnosed myelomeningocele. Patients were qualified for the surgery on the basis of precisely determined inclusion criteria and after assessment by multidisciplinary team of specialists. Surgery was performed between 22nd and 29th week of pregnancy. Fist and second surgery were performed in 29th and 27th week of pregnancy, some patients have undergone the surgery before 26th week of pregnancy. Babies were delivered by cesarean section. Gestational age by the time of the delivery ranged from 25th and 37th and a half week of pregnancy. In two cases the delivery was at term. Main complications included: PROM, placental ablation and vaginal bleeding. In half of all the cases we did not observe hydcephalus increase after the surgery. OFS can be beneficial but it can also carry certain amount of risk both for the fetus and the mother. Therefore, further randomized research deems necessary to better comprehend and determine the safety and effectiveness of such procedures.