open access

Vol 91, No 3 (2020)
ORIGINAL PAPERS Obstetrics
Published online: 2020-03-31
Get Citation

Open fetal surgery for myelomeningocele — is there the learning curve at reduction mother and fetal morbidity?

Ewa I. Horzelska, Mateusz Zamlynski, Tomasz Horzelski, Jacek Zamlynski, Agnieszka Pastuszka, Rafal Bablok, Izabela Herman-Sucharska, Tomasz Koszutski, Anita Olejek
DOI: 10.5603/GP.2020.0028
·
Pubmed: 32266952
·
Ginekol Pol 2020;91(3):123-131.

open access

Vol 91, No 3 (2020)
ORIGINAL PAPERS Obstetrics
Published online: 2020-03-31

Abstract

Objectives: We aimed to show how increased experience of a surgery team in fMMC repair influences maternal and
fetal/neonatal outcomes.
Material and methods: We compare perinatal results of fMMC repair in our Fetal Surgery Center (FSC) in cohort groups for
the early period (2005–2011 year; previous — PFSC, n = 46) and current period (2012–2015 year; current — CFSC, n = 74)
to results of the randomized Management of Myelomeningocele Study (MOMS, 78 patients).
Results: The maternal morbidity due to fMMC repair was low and there was no difference comparing CFSC to PFSC and
MOMS. The frequency of iatrogenic preterm labor (iPTL) ≤ 30 weeks of gestation decreased from 34.1% in PFSC to 23.9%
in CFSC. Iatrogenic preterm premature rupture of membranes (iPPROM) was a common complication after fMMC repair in
all cohorts. The total reduction rate of hindbrain hernation (HH) was similar in CFSC — 90.3% and PFSC — 82.1%.
Conclusions: The increasing experience of our surgery team in fMMC repair majorly decreased the risk of iPTL.

Abstract

Objectives: We aimed to show how increased experience of a surgery team in fMMC repair influences maternal and
fetal/neonatal outcomes.
Material and methods: We compare perinatal results of fMMC repair in our Fetal Surgery Center (FSC) in cohort groups for
the early period (2005–2011 year; previous — PFSC, n = 46) and current period (2012–2015 year; current — CFSC, n = 74)
to results of the randomized Management of Myelomeningocele Study (MOMS, 78 patients).
Results: The maternal morbidity due to fMMC repair was low and there was no difference comparing CFSC to PFSC and
MOMS. The frequency of iatrogenic preterm labor (iPTL) ≤ 30 weeks of gestation decreased from 34.1% in PFSC to 23.9%
in CFSC. Iatrogenic preterm premature rupture of membranes (iPPROM) was a common complication after fMMC repair in
all cohorts. The total reduction rate of hindbrain hernation (HH) was similar in CFSC — 90.3% and PFSC — 82.1%.
Conclusions: The increasing experience of our surgery team in fMMC repair majorly decreased the risk of iPTL.

Get Citation

Keywords

myelomeningocele; fetal surgery; spina bifida; Chiari malformation

About this article
Title

Open fetal surgery for myelomeningocele — is there the learning curve at reduction mother and fetal morbidity?

Journal

Ginekologia Polska

Issue

Vol 91, No 3 (2020)

Pages

123-131

Published online

2020-03-31

DOI

10.5603/GP.2020.0028

Pubmed

32266952

Bibliographic record

Ginekol Pol 2020;91(3):123-131.

Keywords

myelomeningocele
fetal surgery
spina bifida
Chiari malformation

Authors

Ewa I. Horzelska
Mateusz Zamlynski
Tomasz Horzelski
Jacek Zamlynski
Agnieszka Pastuszka
Rafal Bablok
Izabela Herman-Sucharska
Tomasz Koszutski
Anita Olejek

References (35)
  1. Congenital defects in Poland in years 2005-2006. Polish register of congenital defects. Poznan 2010. http://www.rejestrwad.pl/str.php?13.
  2. Giardini V, Russo FM, Ornaghi S, et al. Seasonal impact in the frequency of isolated spina bifida. Prenat Diagn. 2013; 33(10): 1007–1009.
  3. McLone DG, Knepper PA. The cause of Chiari II malformation: a unified theory. Pediatr Neurosci. 1989; 15(1): 1–12.
  4. Heffez DS, Aryanpur J, Hutchins GM, et al. The paralysis associated with myelomeningocele. Neurosurg. 1990: 987–992.
  5. Houtrow AJ, Thom EA, Fletcher JM, et al. MOMS Investigators. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011; 364(11): 993–1004.
  6. Keller BA, Farmer DL. Fetal surgery for myelomeningocele: history, research, clinical trials, and future directions. Minerva Pediatr. 2015; 67(4): 341–356.
  7. Tulipan N, Wellons JC, Thom EA, et al. MOMS Investigators. Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr. 2015; 16(6): 613–620.
  8. Lam S, Harris D, Rocque BG, et al. Pediatric endoscopic third ventriculostomy: a population-based study. J Neurosurg Pediatr. 2014; 14(5): 455–464.
  9. Maher CO, Goumnerova L, Madsen JR, et al. Outcome following multiple repeated spinal cord untethering operations. J Neurosurg. 2007; 106(6 Suppl): 434–438.
  10. Meuli M, Meuli-Simmen C, Hutchins GM, et al. In utero surgery rescues neurological function at birth in sheep with spina bifida. Nat Med. 1995; 1(4): 342–347.
  11. Meuli M, Moehrlen U. Fetal surgery for myelomeningocele is effective: a critical look at the whys. Pediatr Surg Int. 2014; 30(7): 689–697.
  12. Zamłyński J, Olejek A, Koszutski T, et al. Comparison of prenatal and postnatal treatments of spina bifida in Poland--a non-randomized, single-center study. J Matern Fetal Neonatal Med. 2014; 27(14): 1409–1417.
  13. Zamłyńiski J, Olejek A, Bohosiewicz J, et al. [Perinatal results of intrauterine open fetal surgery of fetuses diagnosed with myelomeningocoele--the clinical report of ten cases]. Ginekol Pol. 2007; 78(8): 647–651.
  14. Moron AF, Barbosa MM, Milani HJ, et al. Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study. BJOG. 2018; 125(10): 1280–1286.
  15. Adzick NS. Prospects for fetal surgery. Early Hum Dev. 2013; 89(11): 881–886.
  16. Sutton LN, Adzick NS, Bilaniuk LT, et al. Improvement in hindbrain herniation demonstrated by serial fetal magnetic resonance imaging following fetal surgery for myelomeningocele. JAMA. 1999; 282(19): 1826–1831.
  17. Levine D, Barnes PD, Madsen JR, et al. Central nervous system abnormalities assessed with prenatal magnetic resonance imaging. Obstet Gynecol. 1999; 94(6): 1011–1019.
  18. Morris JE, Rickard S, Paley MNJ, et al. The value of in-utero magnetic resonance imaging in ultrasound diagnosed foetal isolated cerebral ventriculomegaly. Clin Radiol. 2007; 62(2): 140–144.
  19. Zamłyński J, Horzelska E, Zamłyński M, et al. Current views on fetal surgical treatment of myelomeningocele - the Management of Myelomeningocele Study (MOMS) trial and Polish clinical experience. Ginekol Pol. 2017; 88(1): 31–35.
  20. Danzer E, Gerdes M, Bebbington MW, et al. Fetal myelomeningocele surgery: preschool functional status using the Functional Independence Measure for children (WeeFIM). Childs Nerv Syst. 2011; 27(7): 1083–1088.
  21. Danzer E, Thomas NH, Thomas A, et al. Long-term neurofunctional outcome, executive functioning, and behavioral adaptive skills following fetal myelomeningocele surgery. Am J Obstet Gynecol. 2016; 214(2): 269.e1–269.e8.
  22. Golombeck K, Ball RH, Lee H, et al. Maternal morbidity after maternal-fetal surgery. Am J Obstet Gynecol. 2006; 194(3): 834–839.
  23. Bennett KA, Carroll MA, Shannon CN, et al. Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique. J Neurosurg Pediatr. 2014; 14(1): 108–114.
  24. Moldenhauer JS, Soni S, Rintoul NE, et al. Fetal myelomeningocele repair: the post-MOMS experience at the Children's Hospital of Philadelphia. Fetal Diagn Ther. 2015; 37(3): 235–240.
  25. Al-Refai A, Ryan G, Van Mieghem T. Maternal risks of fetal therapy. Curr Opin Obstet Gynecol. 2017; 29(2): 80–84.
  26. Ochsenbein-Kölble N, Krähenmann F, Hüsler M, et al. Tocolysis for in utero Surgery: Atosiban Performs Distinctly Better than Magnesium Sulfate. Fetal Diagn Ther. 2017; 44(1): 59–64.
  27. Soni S, Moldenhauer JS, Spinner SS, et al. Chorioamniotic membrane separation and preterm premature rupture of membranes complicating in utero myelomeningocele repair. Am J Obstet Gynecol. 2016; 214(5): 647.e1–647.e7.
  28. da Silva SA, de Almeida MF, Moron AF, et al. Resuscitation at birth in neonates with meningomyelocele. J Perinat Med. 2014; 42(1): 113–119.
  29. Copp AJ, Adzick NS, Chitty LS, et al. Spina bifida. Nat Rev Dis Primers. 2015; 1: 15007.
  30. Danzer E, Johnson MP, Bebbington M, et al. Fetal head biometry assessed by fetal magnetic resonance imaging following in utero myelomeningocele repair. Fetal Diagn Ther. 2007; 22(1): 1–6.
  31. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 550: maternal-fetal surgery for myelomeningocele. Obstet Gynecol. 2013; 121(1): 218–219.
  32. Wilson R, Wilson R, Audibert F, et al. Prenatal Screening, Diagnosis, and Pregnancy Management of Fetal Neural Tube Defects. J Obstet Gynaecol Can. 2014; 36(10): 927–939.
  33. Meuli M, Moehrlen U, Flake A, et al. Fetal surgery in Zurich: key features of our first open in utero repair of myelomeningocele. Eur J Pediatr Surg. 2013; 23(6): 494–498.
  34. Ovaere C, Eggink A, Richter J, et al. Prenatal diagnosis and patient preferences in patients with neural tube defects around the advent of fetal surgery in Belgium and Holland. Fetal Diagn Ther. 2015; 37(3): 226–234.
  35. Shanmuganathan M, Sival D, Eastwood KA, et al. Prenatal surgery for spina bifida: a therapeutic dilemma. Proceedings of the SHINE conference, Belfast. Ir J Med Sci. 2017; 187(3): 713–718.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl