Current views on fetal surgical treatment of myelomeningocele — the Management of Myelomeningocele Study (MOMS) trial and Polish clinical experience

Zamłyński, Jacek; Horzelska, Ewa; Zamłyński, Mateusz; Olszak-Wąsik, Katarzyna; Nowak, Leszek; Bodzek, Piotr; Horzelski, Tomasz; Bablok, Rafał; Olejek, Anita

doi:10.5603/gp.a2017.0006

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…The Fetal Center at Vanderbilt reported a mean GA of 34.4 ± 3.1 weeks when comparing the MOMS cohort to their post-MOMS cohort [9]. A clinical center in Poland recently published data on their fMMC repair outcomes: 18.3% of their cases reached a GA of 37 weeks (vs. 35.8% in our study population) [10].…”

Section: Discussionmentioning

confidence: 64%

Risk Factors for Preterm Birth following Open Fetal Myelomeningocele Repair: Results from a Prospective Cohort

et al. 2019

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Background: Fetal myelomeningocele (fMMC) repair is a therapeutic option in selected cases. This study aimed to identify risk factors for preterm birth (PTB) following open fMMC repair. Methods: Sixty-seven women underwent fMMC repair and delivered a baby between 2010 and 2018 at our center. Demographic, surgical, and pregnancy complications, including potential risk factors for PTB such as preterm premature rupture of membranes (PPROM), chorioamniotic membrane separation (CMS), and placental abruption were evaluated. Results: Maternal body mass index, maternal age, parity, previous uterine surgery, gestational age at fetal surgery, total surgery duration, surgical subcutaneous hematoma, oligohydramnios, and amniotic fluid leakage were not identified as risk factors for PTB. CMS (p = 0.028, 92 vs. 52%) and PPROM (p = 0.001, 95 vs. 52%) were highly associated with PTB. Placental abruption was found more often in women after fMMC repair than in a general obstetrical population (12 vs. 1%) and ended in premature birth in all cases (p = 0.024, 100 vs. 60%). However, the majority of women delivered at a gestational age >35 weeks. Conclusions: In our study cohort, risk factors for PTB were PPROM, CMS, and placental abruption, whereas surgery duration did not influence outcome. We conclude that the surgery technique should aim to minimize CMS and amniotic fluid leakage.

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Section: Discussionmentioning

confidence: 64%

Risk Factors for Preterm Birth following Open Fetal Myelomeningocele Repair: Results from a Prospective Cohort

et al. 2019

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“…The results of these studies were reported as short term observational studies of cohort groups. The comparison of qualification criteria and surgical protocols remain unanimous [5,12,14,19]. Whereas long-term observation of childhood development after fMMC repair was assessed only in the CHOP study [20,21].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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)(2006)(2007)(2008)(2009)(2010)(2011) year; previous -PFSC, n = 46) and current period (2012)(2013)(2014)(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.

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“…[4]. The Polish team has reported equivalent results as the MOMS trial [30,31]. We matched each child from the OSBAR group with a child from the NSBAR group of the same MMC level and comparable age.…”

Section: Patient Inclusionmentioning

confidence: 99%

Neurologic Outcome Comparison between Fetal Open-, Endoscopic- and Neonatal-Intervention Techniques in Spina Bifida Aperta

et al. 2023

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Introduction: In spina bifida aperta (SBA), fetal closure of the myelomeningocele (MMC) can have a neuroprotective effect and improve outcomes. In Europe, surgical MMC closure is offered by fetal-open (OSBAR), fetal-endoscopic (FSBAR), and neonatal (NSBAR) surgical techniques. Pediatric neurologists facing the challenging task of counseling the parents may therefore seek objective outcome comparisons. Until now, such data are hardly available. In SBA, we aimed to compare neurologic outcomes between OSBAR, FSBAR, and NSBAR intervention techniques. Methods: We determined intervention-related complications, neuromuscular integrity, and neurologic outcome parameters after OSBAR (n = 17) and FSBAR (n = 13) interventions by age- and lesion-matched comparisons with NSBAR-controls. Neurological outcome parameters concerned: shunt dependency, segmental alterations in muscle ultrasound density (reflecting neuromuscular integrity), segmental motor-, sensory- and reflex conditions, and the likelihood of intervention-related gain in ambulation. Results: Compared with NSBAR-controls, fetal intervention is associated with improved neuromuscular tissue integrity, segmental neurological outcomes, reduced shunt dependency, and a higher chance of acquiring ambulation in ≈20% of the operated children. Children with MMC-lesions with a cranial border at L3 revealed the most likely intervention-related motor function gain. The outcome comparison between OSBAR versus FSBAR interventions revealed no significant differences. Conclusion: In SBA, OSBAR- and FSBAR-techniques achieved similar neuroprotective results. A randomized controlled trial is helpful in revealing and compare ongoing effects by surgical learning curves.

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Current views on fetal surgical treatment of myelomeningocele — the Management of Myelomeningocele Study (MOMS) trial and Polish clinical experience

Cited by 7 publications

References 25 publications

Risk Factors for Preterm Birth following Open Fetal Myelomeningocele Repair: Results from a Prospective Cohort

Risk Factors for Preterm Birth following Open Fetal Myelomeningocele Repair: Results from a Prospective Cohort

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

Neurologic Outcome Comparison between Fetal Open-, Endoscopic- and Neonatal-Intervention Techniques in Spina Bifida Aperta

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