open access

Vol 94, No 8 (2023)
Research paper
Published online: 2022-09-19
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Alternative technique of intrauterine myelomeningocele repair to decrease the incidence of unfavorable maternal and fetal outcomes

Tomasz Horzelski1, Ewa I. Horzelska1, Mateusz Zamlynski1, Jacek Zamlynski1, Agnieszka Pastuszka1, Adrianna Marzec1, Anita Olejek1
·
Pubmed: 36121347
·
Ginekol Pol 2023;94(8):625-632.
Affiliations
  1. Gynecology Clinical Care Unit, Department of Obstetrics and Oncological Gynecology Medical University of Silesia, Bytom, Poland

open access

Vol 94, No 8 (2023)
ORIGINAL PAPERS Obstetrics
Published online: 2022-09-19

Abstract

Objectives: The aim of the study was to determine the effectiveness of an alternative method of open fetal surgery to prevent severe unfavorable prenatal events, both for the mother and the fetus.

Material and methods: In this study, the previously published results for a cohort of 46 patients, who had undergone intrauterine myelomeningocele repair (IUMR) at our Center by 2014, constituted the retrospective control group (CG). The MOMS protocol had been applied for hysterotomy, with an automatic uterine stapling device. The study group (SG) n = 57 was assembled during a prospective observation. IUMR was performed using an alternative method of hysterotomy, with the typical opening and closure of the uterus, without automatic stapling device, as described by Moron et al. Additionally, our single-center results were compared with the post-MOMS findings of other centers: Children’s Hospital of Philadelphia (CHOP) and Vanderbilt University Medical Center (VUMC).

Results: No cases of delivery before 30 weeks of gestation (0%, 0/55) were observed in the study group, which is a statistically significant difference (p < 0.05) as compared to controls (15/44). Statistically significantly lower incidence of chorioamniotic separation (5.4% (3/55) vs CHOP 22.9% (22/96), p < 0.001) and contractile activity resulting in preterm labor (16.3% (9/55) vs CHOP 37.5% (36/96), p < 0.05) was found in the study group. Premature rupture of the membranes was statistically significantly less common in the study group as compared to controls, CHOP and VUMC (SG 12.7% (7/55) vs CG 52.2% (24/46), p < 0.001; vs CHOP 32.3% (31/96), p < 0.001; vs VUMC 22% (9/43), p < 0.01, respectively).

Conclusions: The presented IUMR method is associated with improved perinatal outcomes, i.e., lower rates of preterm delivery at < 30 weeks of gestation, preterm premature rupture of membranes, and uterine contractility resulting in preterm delivery. That, in turn, results in lower prematurity rates and, consequently, more favorable neonatal outcomes.

Abstract

Objectives: The aim of the study was to determine the effectiveness of an alternative method of open fetal surgery to prevent severe unfavorable prenatal events, both for the mother and the fetus.

Material and methods: In this study, the previously published results for a cohort of 46 patients, who had undergone intrauterine myelomeningocele repair (IUMR) at our Center by 2014, constituted the retrospective control group (CG). The MOMS protocol had been applied for hysterotomy, with an automatic uterine stapling device. The study group (SG) n = 57 was assembled during a prospective observation. IUMR was performed using an alternative method of hysterotomy, with the typical opening and closure of the uterus, without automatic stapling device, as described by Moron et al. Additionally, our single-center results were compared with the post-MOMS findings of other centers: Children’s Hospital of Philadelphia (CHOP) and Vanderbilt University Medical Center (VUMC).

Results: No cases of delivery before 30 weeks of gestation (0%, 0/55) were observed in the study group, which is a statistically significant difference (p < 0.05) as compared to controls (15/44). Statistically significantly lower incidence of chorioamniotic separation (5.4% (3/55) vs CHOP 22.9% (22/96), p < 0.001) and contractile activity resulting in preterm labor (16.3% (9/55) vs CHOP 37.5% (36/96), p < 0.05) was found in the study group. Premature rupture of the membranes was statistically significantly less common in the study group as compared to controls, CHOP and VUMC (SG 12.7% (7/55) vs CG 52.2% (24/46), p < 0.001; vs CHOP 32.3% (31/96), p < 0.001; vs VUMC 22% (9/43), p < 0.01, respectively).

Conclusions: The presented IUMR method is associated with improved perinatal outcomes, i.e., lower rates of preterm delivery at < 30 weeks of gestation, preterm premature rupture of membranes, and uterine contractility resulting in preterm delivery. That, in turn, results in lower prematurity rates and, consequently, more favorable neonatal outcomes.

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Keywords

myelomeningocele; fetal surgery; complications; alternative technique

About this article
Title

Alternative technique of intrauterine myelomeningocele repair to decrease the incidence of unfavorable maternal and fetal outcomes

Journal

Ginekologia Polska

Issue

Vol 94, No 8 (2023)

Article type

Research paper

Pages

625-632

Published online

2022-09-19

Page views

1042

Article views/downloads

443

DOI

10.5603/GP.a2022.0098

Pubmed

36121347

Bibliographic record

Ginekol Pol 2023;94(8):625-632.

Keywords

myelomeningocele
fetal surgery
complications
alternative technique

Authors

Tomasz Horzelski
Ewa I. Horzelska
Mateusz Zamlynski
Jacek Zamlynski
Agnieszka Pastuszka
Adrianna Marzec
Anita Olejek

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