Fetal Surgery for Myelomeningocele

A Systematic Review and Meta-Analysis of Outcomes in Fetoscopic versus Open Repair

Sandra K. Kabagambe, Guy W. Jensen, Yue Julia Chen, Melissa A. Vanover, Diana L Farmer

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background/Objectives: The Management of Myelomeningocele (MMC) Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes but was associated with high rates of obstetrical complications. This study compares outcomes of open and fetoscopic MMC repair. Data Sources: PubMed and Embase studies reporting outcomes of fetal MMC repair published since the completion of the MOMS. Results: We analyzed 11 studies and found no difference in mortality or the rate of shunt placement for hydrocephalus. Percutaneous fetoscopic repair was associated with higher rates of premature rupture of membranes (91 vs. 36%, p < 0.01) and preterm birth (96 vs. 81%, p = 0.04) compared to open repair, whereas fetoscopic repair via maternal laparotomy reduced preterm birth. The rate of dehiscence and leakage from the MMC repair site was higher after both types of fetoscopic surgery (30 vs. 7%, p < 0.01), while the rate of uterine dehiscence was higher after open repair (11 vs. 0%, p < 0.01). Discussion: Fetoscopic repair is a promising alternative to open fetal MMC repair with a lower risk of uterine dehiscence; however, fetoscopic techniques should be optimized to overcome the high rate of dehiscence and leakage at the MMC repair site. A fetoscopic approach via maternal laparotomy reduces the risk of preterm birth.

Original languageEnglish (US)
JournalFetal Diagnosis and Therapy
DOIs
StateAccepted/In press - Sep 15 2017

Fingerprint

Meningomyelocele
Meta-Analysis
Premature Birth
Laparotomy
Fetoscopy
Mothers
Outcome Assessment (Health Care)
Information Storage and Retrieval
Hydrocephalus
PubMed
Rupture
Membranes
Mortality

Keywords

  • Fetal surgery
  • Fetoscopy
  • Myelomeningocele
  • Prenatal treatment
  • Spina bifida

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

Fetal Surgery for Myelomeningocele : A Systematic Review and Meta-Analysis of Outcomes in Fetoscopic versus Open Repair. / Kabagambe, Sandra K.; Jensen, Guy W.; Chen, Yue Julia; Vanover, Melissa A.; Farmer, Diana L.

In: Fetal Diagnosis and Therapy, 15.09.2017.

Research output: Contribution to journalArticle

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