Maternal morbidity after maternal-fetal surgery

Kirstin Golombeck, Robert H. Ball, Hanmin Lee, Jody A. Farrell, Diana L Farmer, Volker R. Jacobs, Mark A. Rosen, Roy A. Filly, Michael R. Harrison

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Objective: There is a paucity of published data on the maternal risks of fetal surgical interventions. We analyzed maternal morbidity and mortality that were associated with different types of fetal intervention (open hysterotomy, various endoscopic procedures and percutaneous techniques) to quantify this risk. Study design: We performed a retrospective evaluation of a continuous series of 187 cases that had been performed between July 1989 and May 2003 at the Fetal Treatment Center, a highly specialized interdisciplinary center for fetal surgery at the University of California, San Francisco. The primary outcome was the frequency of maternal morbidity for open, endoscopic, and percutaneous procedures to access the fetus. Results: There were 187 pregnant women with confirmed major fetal malformations who were candidates for intrauterine fetal intervention. Maternal-fetal surgery was performed in 87 cases by open hysterotomy, in 69 cases by endoscopic procedures, and in 31 cases by percutaneous techniques. There were no maternal deaths, but significant short-term morbidity was observed. There were no significant differences in the incidence of premature rupture of membranes, pulmonary edema, placental abruption, postoperative vaginal bleeding, preterm delivery, or interval from maternal-fetal surgery to delivery between endoscopic procedures and open surgery. Complications were significantly less in the percutaneous ultrasound-guided procedures. Endoscopic procedures, even with a laparotomy, showed statistically significantly less morbidity compared with the open hysterotomy group regarding cesarean delivery as delivery mode (94.8% vs 58.8%; P < .001), requirement for intensive care unit stay (1.4% vs 26.4%; P < .001), length of hospital stay (7.9 vs 11.9 days; P = .001), and requirement for blood transfusions (2.9% vs 12.6%; P = .022). Chorion-amnion membrane separation (64.7% vs 20.3%; P < .001) was seen more often in the endoscopy group. Conclusion: Short-term morbidities include increased rates of cesarean birth, treatment in intensive care, prolonged hospitalization, and blood transfusion, all of which were more common with hysterotomy compared with other techniques. Maternal-fetal surgery can be performed without maternal death. Results from this study provide helpful data for counseling prospective patients.

Original languageEnglish (US)
Pages (from-to)834-839
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume194
Issue number3
DOIs
StatePublished - Mar 2006

Fingerprint

Hysterotomy
Mothers
Morbidity
Maternal Death
Blood Transfusion
Length of Stay
Abruptio Placentae
Chorion
Amnion
Membranes
San Francisco
Uterine Hemorrhage
Maternal Mortality
Birth Rate
Pulmonary Edema
Critical Care
Laparotomy
Endoscopy
Intensive Care Units
Counseling

Keywords

  • Fetal surgery
  • Fetendo
  • Fetoscopic surgery
  • Maternal morbidity
  • Maternal-fetal surgery
  • Percutaneous ultrasound-guided procedures

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Golombeck, K., Ball, R. H., Lee, H., Farrell, J. A., Farmer, D. L., Jacobs, V. R., ... Harrison, M. R. (2006). Maternal morbidity after maternal-fetal surgery. American Journal of Obstetrics and Gynecology, 194(3), 834-839. https://doi.org/10.1016/j.ajog.2005.10.807

Maternal morbidity after maternal-fetal surgery. / Golombeck, Kirstin; Ball, Robert H.; Lee, Hanmin; Farrell, Jody A.; Farmer, Diana L; Jacobs, Volker R.; Rosen, Mark A.; Filly, Roy A.; Harrison, Michael R.

In: American Journal of Obstetrics and Gynecology, Vol. 194, No. 3, 03.2006, p. 834-839.

Research output: Contribution to journalArticle

Golombeck, K, Ball, RH, Lee, H, Farrell, JA, Farmer, DL, Jacobs, VR, Rosen, MA, Filly, RA & Harrison, MR 2006, 'Maternal morbidity after maternal-fetal surgery', American Journal of Obstetrics and Gynecology, vol. 194, no. 3, pp. 834-839. https://doi.org/10.1016/j.ajog.2005.10.807
Golombeck, Kirstin ; Ball, Robert H. ; Lee, Hanmin ; Farrell, Jody A. ; Farmer, Diana L ; Jacobs, Volker R. ; Rosen, Mark A. ; Filly, Roy A. ; Harrison, Michael R. / Maternal morbidity after maternal-fetal surgery. In: American Journal of Obstetrics and Gynecology. 2006 ; Vol. 194, No. 3. pp. 834-839.
@article{0549af4f168e484a9dd448ed6312c052,
title = "Maternal morbidity after maternal-fetal surgery",
abstract = "Objective: There is a paucity of published data on the maternal risks of fetal surgical interventions. We analyzed maternal morbidity and mortality that were associated with different types of fetal intervention (open hysterotomy, various endoscopic procedures and percutaneous techniques) to quantify this risk. Study design: We performed a retrospective evaluation of a continuous series of 187 cases that had been performed between July 1989 and May 2003 at the Fetal Treatment Center, a highly specialized interdisciplinary center for fetal surgery at the University of California, San Francisco. The primary outcome was the frequency of maternal morbidity for open, endoscopic, and percutaneous procedures to access the fetus. Results: There were 187 pregnant women with confirmed major fetal malformations who were candidates for intrauterine fetal intervention. Maternal-fetal surgery was performed in 87 cases by open hysterotomy, in 69 cases by endoscopic procedures, and in 31 cases by percutaneous techniques. There were no maternal deaths, but significant short-term morbidity was observed. There were no significant differences in the incidence of premature rupture of membranes, pulmonary edema, placental abruption, postoperative vaginal bleeding, preterm delivery, or interval from maternal-fetal surgery to delivery between endoscopic procedures and open surgery. Complications were significantly less in the percutaneous ultrasound-guided procedures. Endoscopic procedures, even with a laparotomy, showed statistically significantly less morbidity compared with the open hysterotomy group regarding cesarean delivery as delivery mode (94.8{\%} vs 58.8{\%}; P < .001), requirement for intensive care unit stay (1.4{\%} vs 26.4{\%}; P < .001), length of hospital stay (7.9 vs 11.9 days; P = .001), and requirement for blood transfusions (2.9{\%} vs 12.6{\%}; P = .022). Chorion-amnion membrane separation (64.7{\%} vs 20.3{\%}; P < .001) was seen more often in the endoscopy group. Conclusion: Short-term morbidities include increased rates of cesarean birth, treatment in intensive care, prolonged hospitalization, and blood transfusion, all of which were more common with hysterotomy compared with other techniques. Maternal-fetal surgery can be performed without maternal death. Results from this study provide helpful data for counseling prospective patients.",
keywords = "Fetal surgery, Fetendo, Fetoscopic surgery, Maternal morbidity, Maternal-fetal surgery, Percutaneous ultrasound-guided procedures",
author = "Kirstin Golombeck and Ball, {Robert H.} and Hanmin Lee and Farrell, {Jody A.} and Farmer, {Diana L} and Jacobs, {Volker R.} and Rosen, {Mark A.} and Filly, {Roy A.} and Harrison, {Michael R.}",
year = "2006",
month = "3",
doi = "10.1016/j.ajog.2005.10.807",
language = "English (US)",
volume = "194",
pages = "834--839",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Maternal morbidity after maternal-fetal surgery

AU - Golombeck, Kirstin

AU - Ball, Robert H.

AU - Lee, Hanmin

AU - Farrell, Jody A.

AU - Farmer, Diana L

AU - Jacobs, Volker R.

AU - Rosen, Mark A.

AU - Filly, Roy A.

AU - Harrison, Michael R.

PY - 2006/3

Y1 - 2006/3

N2 - Objective: There is a paucity of published data on the maternal risks of fetal surgical interventions. We analyzed maternal morbidity and mortality that were associated with different types of fetal intervention (open hysterotomy, various endoscopic procedures and percutaneous techniques) to quantify this risk. Study design: We performed a retrospective evaluation of a continuous series of 187 cases that had been performed between July 1989 and May 2003 at the Fetal Treatment Center, a highly specialized interdisciplinary center for fetal surgery at the University of California, San Francisco. The primary outcome was the frequency of maternal morbidity for open, endoscopic, and percutaneous procedures to access the fetus. Results: There were 187 pregnant women with confirmed major fetal malformations who were candidates for intrauterine fetal intervention. Maternal-fetal surgery was performed in 87 cases by open hysterotomy, in 69 cases by endoscopic procedures, and in 31 cases by percutaneous techniques. There were no maternal deaths, but significant short-term morbidity was observed. There were no significant differences in the incidence of premature rupture of membranes, pulmonary edema, placental abruption, postoperative vaginal bleeding, preterm delivery, or interval from maternal-fetal surgery to delivery between endoscopic procedures and open surgery. Complications were significantly less in the percutaneous ultrasound-guided procedures. Endoscopic procedures, even with a laparotomy, showed statistically significantly less morbidity compared with the open hysterotomy group regarding cesarean delivery as delivery mode (94.8% vs 58.8%; P < .001), requirement for intensive care unit stay (1.4% vs 26.4%; P < .001), length of hospital stay (7.9 vs 11.9 days; P = .001), and requirement for blood transfusions (2.9% vs 12.6%; P = .022). Chorion-amnion membrane separation (64.7% vs 20.3%; P < .001) was seen more often in the endoscopy group. Conclusion: Short-term morbidities include increased rates of cesarean birth, treatment in intensive care, prolonged hospitalization, and blood transfusion, all of which were more common with hysterotomy compared with other techniques. Maternal-fetal surgery can be performed without maternal death. Results from this study provide helpful data for counseling prospective patients.

AB - Objective: There is a paucity of published data on the maternal risks of fetal surgical interventions. We analyzed maternal morbidity and mortality that were associated with different types of fetal intervention (open hysterotomy, various endoscopic procedures and percutaneous techniques) to quantify this risk. Study design: We performed a retrospective evaluation of a continuous series of 187 cases that had been performed between July 1989 and May 2003 at the Fetal Treatment Center, a highly specialized interdisciplinary center for fetal surgery at the University of California, San Francisco. The primary outcome was the frequency of maternal morbidity for open, endoscopic, and percutaneous procedures to access the fetus. Results: There were 187 pregnant women with confirmed major fetal malformations who were candidates for intrauterine fetal intervention. Maternal-fetal surgery was performed in 87 cases by open hysterotomy, in 69 cases by endoscopic procedures, and in 31 cases by percutaneous techniques. There were no maternal deaths, but significant short-term morbidity was observed. There were no significant differences in the incidence of premature rupture of membranes, pulmonary edema, placental abruption, postoperative vaginal bleeding, preterm delivery, or interval from maternal-fetal surgery to delivery between endoscopic procedures and open surgery. Complications were significantly less in the percutaneous ultrasound-guided procedures. Endoscopic procedures, even with a laparotomy, showed statistically significantly less morbidity compared with the open hysterotomy group regarding cesarean delivery as delivery mode (94.8% vs 58.8%; P < .001), requirement for intensive care unit stay (1.4% vs 26.4%; P < .001), length of hospital stay (7.9 vs 11.9 days; P = .001), and requirement for blood transfusions (2.9% vs 12.6%; P = .022). Chorion-amnion membrane separation (64.7% vs 20.3%; P < .001) was seen more often in the endoscopy group. Conclusion: Short-term morbidities include increased rates of cesarean birth, treatment in intensive care, prolonged hospitalization, and blood transfusion, all of which were more common with hysterotomy compared with other techniques. Maternal-fetal surgery can be performed without maternal death. Results from this study provide helpful data for counseling prospective patients.

KW - Fetal surgery

KW - Fetendo

KW - Fetoscopic surgery

KW - Maternal morbidity

KW - Maternal-fetal surgery

KW - Percutaneous ultrasound-guided procedures

UR - http://www.scopus.com/inward/record.url?scp=33644700362&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644700362&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2005.10.807

DO - 10.1016/j.ajog.2005.10.807

M3 - Article

C2 - 16522421

AN - SCOPUS:33644700362

VL - 194

SP - 834

EP - 839

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 3

ER -