In utero Hepatitis B Immunization during Fetal Surgery for Spina Bifida

INTRODUCTION: In select cases, in utero surgery for MMC leads to better outcomes than postnatal repair. However, maternal HIV infection constitutes a formal exclusion criterion due to the potential of vertical HIV transmission. Encouraged by a previous case of a successful fetal spina bifida repair in a Hepatitis Bs antigen positive woman, a plan was devised allowing for fetal surgery. CASE REPORT: In utero MMC repair was performed although the mother was HIV-infected. To minimize the risk of in utero HIV transmission, the mother was treated by HAART throughout gestation as well as intravenous zidovudine administration during maternal-fetal surgery. The mother tolerated all procedures very well without any sequelae. The currently 20 month-old toddler, is HIV negative and has significantly benefitted from fetal surgery. DISCUSSION/CONCLUSION: This case shows that maternal HIV is not a priori a diagnosis that excludes fetal surgery. Rather, it might be a surrogate for moving towards personalized medicine and away from applying too rigorous exclusion criteria in the selection of candidates for maternal-fetal surgery.

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Getting earlier, smaller and regenerative: The next 10 years of in utero spina bifida repair.

Prenatal Diagnosis ◽

10.1002/pd.6004 ◽

2021 ◽

Author(s):

Dominic NP Thompson ◽

Paolo De Coppi

Keyword(s):

Spina Bifida ◽

In Utero

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81 A three-layer fetoscopic spina bifida closure has fewer neonatal complications than open in-utero closure

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.082 ◽

2021 ◽

Vol 224 (2) ◽

pp. S56-S57

Author(s):

Jimmy Espinoza ◽

Michael A. Belfort ◽

William Whitehead ◽

Magdalena Sanz-Cortes ◽

Ahmed A. Nassr ◽

...

Keyword(s):

Spina Bifida ◽

In Utero ◽

Neonatal Complications

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‘We did everything we could’– A qualitative study exploring the acceptability of maternal‐fetal surgery for spina bifida to parents

Prenatal Diagnosis ◽

10.1002/pd.5996 ◽

2021 ◽

Author(s):

Neeltje Crombag ◽

Adalina Sacco ◽

Bernadette Stocks ◽

Philippe De Vloo ◽

Johannes Van Der Merwe ◽

...

Keyword(s):

Spina Bifida ◽

Qualitative Study ◽

Fetal Surgery

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

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2005.02.071 ◽

2005 ◽

Vol 193 (3) ◽

pp. 727-731 ◽

Cited By ~ 9

Author(s):

Amy Adelberg ◽

Angela Blotzer ◽

Gary Koch ◽

Rachael Moise ◽

Nancy Chescheir ◽

...

Keyword(s):

Fetal Surgery ◽

In Utero

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VP51.04: Options for intrauterine correction of spina bifida by open and fetoscopic fetal surgery: a systematic review

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.24723 ◽

2021 ◽

Vol 58 (S1) ◽

pp. 306-306

Author(s):

L. Lara‐Ávila ◽

M. Martinez‐Rodriguez ◽

R. Villalobos‐Gómez ◽

H. López‐Briones ◽

R. Cruz‐Martinez

Keyword(s):

Systematic Review ◽

Spina Bifida ◽

Fetal Surgery

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Fetal Surgery for Spina Bifida

Cerebrospinal Fluid Disorders ◽

10.3109/9781420016284-33 ◽

2016 ◽

pp. 548-554

Keyword(s):

Spina Bifida ◽

Fetal Surgery

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Open Spina Bifida: Why Not Fetal Surgery?

Fetal Diagnosis and Therapy ◽

10.1159/000491751 ◽

2018 ◽

Vol 45 (6) ◽

pp. 430-434 ◽

Cited By ~ 1

Author(s):

Luca Mazzone ◽

Ueli Moehrlen ◽

Barbara Casanova ◽

Samira Ryf ◽

Nicole Ochsenbein-Kölble ◽

...

Keyword(s):

Spina Bifida ◽

Fetal Surgery ◽

Open Spina Bifida

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Fetal surgery for spina bifida aperta

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-315143 ◽

2018 ◽

Vol 103 (6) ◽

pp. F589-F595 ◽

Cited By ~ 12

Author(s):

Luc Joyeux ◽

Enrico Danzer ◽

Alan W Flake ◽

Jan Deprest

Keyword(s):

Spina Bifida ◽

Prolonged Exposure ◽

Controlled Trial ◽

Fetal Surgery ◽

Neurological Deficits ◽

Cerebrospinal Fluid Leakage ◽

Essential Information ◽

Ventriculoperitoneal Shunting ◽

Spina Bifida Aperta ◽

Randomised Controlled

Spina bifida aperta (SBA) is one of the most common congenital malformations. It can cause severe lifelong physical and neurodevelopmental disabilities. Experimental and clinical studies have shown that the neurological deficits associated with SBA are not simply caused by incomplete neurulation at the level of the lesion. Additional damage is caused by prolonged exposure of the spinal cord and nerves to the intrauterine environment and a suction gradient due to cerebrospinal fluid leakage, leading to progressive downward displacement of the hindbrain. This natural history can be reversed by prenatal repair. A randomised controlled trial demonstrated that mid-gestational maternal-fetal surgery for SBA decreases the need for ventriculoperitoneal shunting and hindbrain herniation at 12 months and improves neurological motor function at 30 months of age. This came at the price of maternal and fetal risks, the most relevant ones being increased prematurity and a persistent uterine corporeal scar. Recently minimally invasive fetal approaches have been introduced clinically yet they lack extensive experimental or clinical trials. We aim to provide clinicians with the essential information necessary to counsel SBA parents as the basis for considering referral of selected patients to expert fetal surgery centres. We review the reported clinical outcomes and discuss recent developments of potentially less invasive fetal SBA approaches.

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