Open fetal surgery for myelomeningocele - is there the learning curve at reduction mother and fetal morbidity?

Ginekol Pol. 2020;91(3):123-131. doi: 10.5603/GP.2020.0028.

Abstract

Objectives: We aimed to show how increased experience of a surgery team in fMMC repair influences maternal and fetal/neonatal outcomes.

Material and methods: We compare perinatal results of fMMC repair in our Fetal Surgery Center (FSC) in cohort groups for the early period (2005-2011 year; previous - PFSC, n = 46) and current period (2012-2015 year; current - CFSC, n = 74) to results of the randomized Management of Myelomeningocele Study (MOMS, 78 patients).

Results: The maternal morbidity due to fMMC repair was low and there was no difference comparing CFSC to PFSC and MOMS. The frequency of iatrogenic preterm labor (iPTL) ≤ 30 weeks of gestation decreased from 34.1% in PFSC to 23.9% in CFSC. Iatrogenic preterm premature rupture of membranes (iPPROM) was a common complication after fMMC repair in all cohorts. The total reduction rate of hindbrain hernation (HH) was similar in CFSC - 90.3% and PFSC - 82.1%.

Conclusions: The increasing experience of our surgery team in fMMC repair majorly decreased the risk of iPTL.

Keywords: Chiari malformation; fetal surgery; myelomeningocele; spina bifida.

Publication types

  • Comparative Study

MeSH terms

  • Cohort Studies
  • Female
  • Fetal Membranes, Premature Rupture / epidemiology
  • Fetal Membranes, Premature Rupture / etiology
  • Fetoscopy* / adverse effects
  • Fetoscopy* / education
  • Fetoscopy* / standards
  • Fetoscopy* / statistics & numerical data
  • Humans
  • Learning Curve
  • Meningomyelocele / surgery*
  • Pregnancy
  • Pregnancy Outcome / epidemiology
  • Surgeons / education

Supplementary concepts

  • Preterm Premature Rupture of the Membranes