Experience of 300 cases of prenatal fetoscopic open spina bifida repair: report of the International Fetoscopic Neural Tube Defect Repair Consortium

Cortés, Magdalena Sanz; Chmait, Ramen H.; Lapa, D.A.; Belfort, Michael A.; Carreras, E.; Miller, Jena L.; Brawura-Biskupski-Samaha, Robert; González, Gerardo Sepúlveda; Gielchinsky, Yuval; Yamamoto, M.; Persico, Nicola; Santorum, Marta; Otaño, Lucas; Nicolaou, E; Yinon, Yoav; FAIG-LEITE, Fernanda; Brandt, Reynaldo André; Whitehead, William E.; Maíz, Nerea; Baschat, Ahmet; Kosiński, Przemysław; Nieto-Sanjuanero, Adriana; Chu, Jason; Kershenovich, Amir; Nicolaides, Kypros H.

doi:10.1016/j.ajog.2021.05.044

Cited by 63 publications

(48 citation statements)

References 24 publications

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“…As fetoscopic IRSBA is in its early stages in Latin America, consistent and proper implementation and training are required before this can be considered a valid technique in centers outside the USA and Brazil. 36…”

Section: Discussionmentioning

confidence: 99%

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Open intrauterine repair of spina bifida aperta: Historical aspects, current availability, and clinical outcomes from the Latin American Spina Bifida Consortium

et al. 2021

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Objective: To determine the historical aspects, current availability, and clinical outcomes of open intrauterine repair of spina bifida aperta (IRSBA) in Spanishspeaking Latin American countries. Methods: Cases were collected from centers with at least 2 years of experience and a minimum of 10 open IRSBA interventions by December 2020. Clinical variables were compared to the results of the Management of Myelomeningocele Study (MOMS) trial.Results: Clinical experience with 314 cases from seven centers was reviewed. Most cases (n = 189, 60.2%) were performed between 24 and 25.9 weeks' gestation.Delivery at less than 30 weeks' gestation occurred in 36 cases (11.5%) and the overall perinatal mortality rate was 5.4% (17 of 314). The rate of maternal complications was low, including the need for blood transfusion (n = 3, 0.9%) and dehiscence or a thin uterine scar (n = 4, 1.3%). No cases of maternal death were recorded. Fifteen neonates required additional surgical repair of the spinal defect (4.8%) and 63 of 167 infants (37.7%) required a cerebrospinal fluid diversion procedure. Only two of the seven centers reported preliminary experience with fetoscopic IRSBA.Conclusions: Clinical experience and outcomes were within the expected results reported by the MOMS trial. There is still very limited experience with fetoscopic IRSBA in this part of the world. Key pointsWhat is already known about this topic? � Intrauterine repair of spina bifida aperta (IRSBA) is a well-established option for the management of second-trimester fetuses affected by this neural tube defect.� Aside from Brazil, there is little information available on outcomes from fetal surgery centers in Latin America.Collaborators are listed in the Appendix section of the manuscript.

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Section: Discussionmentioning

confidence: 99%

“…± 3.2 weeks' gestation (range,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Overall, severe premature delivery occurring at <30 weeks was recorded in 36 of these cases (11.5%), delivery between 30 and 34 weeks in 118 cases (37.6%), and delivery at ≥35 weeks in 160 cases (51.0%).…”

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confidence: 99%

Open intrauterine repair of spina bifida aperta: Historical aspects, current availability, and clinical outcomes from the Latin American Spina Bifida Consortium

et al. 2021

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“…Percutaneous interventions include ultrasonographyguided bipolar cord coagulation, 99,100 radio frequency ablation, 101 shunt procedures [102][103][104][105][106][107][108][109][110] and fetoscopy for laser umbilical cord occlusion, 111 laser ablation of placental vascular anastomoses, 112,113 fetoscopic endotracheal occlusion, 114 amniotic band resection, 115 and percutaneous fetal myelomeningocele closure [116][117][118][119] (Table 2). Fetoscopic interventions or bipolar forceps procedures are performed using a combination of ultrasonographic guidance and direct visualization, entering the uterus directly or through a sheath.…”

Section: Percutaneous Fetal Interventionsmentioning

confidence: 99%

Care Levels for Fetal Therapy Centers

Baschat¹,

Blackwell²,

Chatterjee³

et al. 2022

Obstetrics &Amp; Gynecology

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Fetal therapies undertaken to improve fetal outcome or to optimize transition to neonate life often entail some level of maternal, fetal, or neonatal risk. A fetal therapy center needs access to resources to carry out such therapies and to manage maternal, fetal, and neonatal complications that might arise, either related to the therapy per se or as part of the underlying fetal or maternal condition. Accordingly, a fetal therapy center requires a dedicated operational infrastructure and necessary resources to allow for appropriate oversight and monitoring of clinical performance and to facilitate multidisciplinary collaboration between the relevant specialties. Three care levels for fetal therapy centers are proposed to match the anticipated care complexity,

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“…Main findings of the MOM study that support performing surgery in the fetal period Fetoscopic views of a myelomeningocele repair at GA 26 weeks Published 2014 2016 2017 2021 N 51 10 28 300 non completed surgeries 0 1 6 15 Completed surgeries 51 9 22 285 GA at surgery 23 (21-29) 27 (25-28) 25 (22-26) 25.9 (22.7-31.6) Mean operating time (range) 223 242 250 204 (72-458) Mean GA at delivery 33 32 38 34 Deliveries under 30 weeks 11% 20% 5% 14% Perinatal deaths 4 2 0 5 Ventriculoperitoneal shunt. 45% 40% 20% 43%[121]. A recent publication of all groups of fetoscopic closure of myelomeningocele reported similar neurological outcome of that of open surgery, avoiding maternal risks.…”

mentioning

confidence: 99%