Impact of maternal-fetal surgery for myelomeningocele on the progression of ventriculomegaly in utero

Background: Fetal surgery, such as for meningomyelocele repair, has a clear clinical fetal benefit. In patients who undergo in utero repair of meningomyelocele, for example, there is reduced long-term disease morbidity. However, despite the beneficial effects of early intervention, women who undergo fetal interventions have an increased risk of preterm labor and delivery. Several surgery-related factors have been described but no specific anesthesia-related factors. Objective: The aim of this study was to determine if any aspects of the perioperative anesthetic management influenced maternal complications following in utero surgery. Methods: This was a retrospective chart review of the anesthetic management of mothers and fetuses who presented for open and fetoscopic myelomeningocele repair, between 2011 and 2015, at Texas Children’s Fetal Center®. Results: Forty-six women underwent open or fetoscopic repair of neural tube defects at our institution. We found the maternal heart rate in the postoperative period to be associated with a higher likelihood of preterm labor, but not delivery. The odds of having preterm delivery was higher for nulliparous patients and those with lower intraoperative diastolic pressure. Conclusions: Our findings confirm what has been previously reported regarding the association of nulliparity with preterm delivery. Additionally, this study highlights the importance of maintaining stable perioperative hemodynamics during the intraoperative and postoperative phases of care for patients undergoing in utero surgery.

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In utero Hepatitis B Immunization during Fetal Surgery for Spina Bifida

Fetal Diagnosis and Therapy ◽

10.1159/000503447 ◽

2019 ◽

Vol 47 (4) ◽

pp. 328-332 ◽

Cited By ~ 3

Author(s):

Ueli Moehrlen ◽

Julia Elrod ◽

Nicole Ochsenbein-Kölble ◽

Christoph Berger ◽

Roberto F. Speck ◽

...

Keyword(s):

Spina Bifida ◽

Hepatitis B ◽

Fetal Surgery ◽

In Utero

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In utero fetal surgery. Resolution 73 (I-81) council on scientific affairs

JAMA ◽

10.1001/jama.250.11.1443 ◽

1983 ◽

Vol 250 (11) ◽

pp. 1443-1444 ◽

Cited By ~ 1

Keyword(s):

Fetal Surgery ◽

In Utero

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In utero fetal surgery. Resolution 73 (1–81)

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(84)80203-1 ◽

1984 ◽

Vol 19 (3) ◽

pp. 321-322

Author(s):

David L. Collins

Keyword(s):

Fetal Surgery ◽

In Utero

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Fetal Lung Surgery

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1474 ◽

2016 ◽

Vol 10 (3) ◽

pp. 271-296

Author(s):

Gokhan Goynumer ◽

Olus Api ◽

Murat Yayla ◽

Cihat Sen

Keyword(s):

Perinatal Care ◽

Surgical Techniques ◽

Fetal Surgery ◽

Expectant Management ◽

Fetal Lung ◽

In Utero ◽

Lung Surgery ◽

Technological Advances ◽

Before And After ◽

Increasing Demand

ABSTRACT Advances in technology and wide used of obstetric ultrasound have allowed an increase in the antenatal identification of fetal problems, such as fetal lung lesions. Technological advances in transducer and software technology have remarkably improved visualization of structures in the fetus. Additionally, newer understanding of the natural course of several malformations and new methods of in utero treatment, the evolution of fetal surgical techniques and anesthesia have made fetal surgery possible and have changed the course of evolution of lung defects before and after birth. Therefore, there is now an increasing demand for an accurate and timely diagnosis, counseling, and planning of appropriate management of the cases whether expectant management or in utero therapy at perinatal care centers with timely perinatal transfer. How to cite this article Sen C, Yayla M, Api O, Goynumer G. Fetal Lung Surgery. Donald School J Ultrasound Obstet Gynecol 2016;10(3):271-296.

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In utero diagnosis of intrapericardial teratoma: a case forin utero open fetal surgery

Prenatal Diagnosis ◽

10.1002/(sici)1097-0223(199812)18:12<1328::aid-pd454>3.0.co;2-7 ◽

1998 ◽

Vol 18 (12) ◽

pp. 1328-1330 ◽

Cited By ~ 21

Author(s):

Shlomit Riskin-Mashiah ◽

Kenneth J. Moise ◽

Isabelle Wilkins ◽

Nancy A. Ayres ◽

Charles D. Fraser

Keyword(s):

Fetal Surgery ◽

In Utero

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In utero fetal surgery using a milliwatt carbon dioxide laser

Lasers in Surgery and Medicine ◽

10.1002/lsm.1900090510 ◽

1989 ◽

Vol 9 (5) ◽

pp. 482-484 ◽

Cited By ~ 2

Author(s):

Geoffrey G. Hallock ◽

David C. Rice

Keyword(s):

Carbon Dioxide ◽

Carbon Dioxide Laser ◽

Fetal Surgery ◽

In Utero

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Effects of Ritodrine and Fetal Oxygenation after in utero Fetal Surgery in Sheep

Neonatology ◽

10.1159/000243108 ◽

1989 ◽

Vol 56 (2) ◽

pp. 94-100 ◽

Cited By ~ 1

Author(s):

Barry S. Block ◽

Julian T. Parer ◽

Anibal J. Llanos ◽

Denys J. Court

Keyword(s):

Fetal Surgery ◽

In Utero ◽

Fetal Oxygenation

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Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center

Neurosurgical FOCUS ◽

10.3171/2019.8.focus19438 ◽

2019 ◽

Vol 47 (4) ◽

pp. E12 ◽

Cited By ~ 2

Author(s):

Giorgio Carrabba ◽

Francesco Macchini ◽

Isabella Fabietti ◽

Luigi Schisano ◽

Giulia Meccariello ◽

...

Keyword(s):

Gestational Age ◽

Fetal Surgery ◽

Preoperative Assessment ◽

In Utero ◽

Maternal Complications ◽

Preliminary Results ◽

Neurological Outcomes ◽

Csf Leakage ◽

Hindbrain Herniation ◽

The Mean

OBJECTIVERecent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors’ aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalus, and radiological outcomes.METHODSPreoperative assessment included clinical examination, ultrasound imaging, and MRI of the fetus. Patients underwent purely fetoscopic in utero MMC repair, followed by postoperative in utero and postnatal MRI. All participants received multidisciplinary follow-up.RESULTSFive pregnant women carrying fetuses affected by MMC signed informed consent for the fetoscopic treatment of the defect. The mean MMC size was 30.4 mm (range 19–49 mm). Defect locations were L1 (2 cases), L5 (2 cases), and L4 (1 case). Hindbrain herniation and ventriculomegaly were documented in all cases. The mean gestational age at surgery was 28.2 weeks (range 27.8–28.8 weeks). Fetoscopic repair was performed in all cases. The mean gestational age at delivery was 33.9 weeks (range 29.3–37.4 weeks). After surgery, reversal of hindbrain herniation was documented in all cases. Three newborns developed signs of hydrocephalus requiring CSF diversion. Neurological outcomes in terms of motor level were favorable in all cases, but a premature newborn died due to CSF infection and sepsis.CONCLUSIONSThe authors’ preliminary results suggest that fetoscopic treatment of MMC is feasible, reproducible, and safe for mothers and their babies. Neurological outcomes were favorable and similar to those in the available literature. As known, prematurity was the greatest complication.

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