Fetal open spinal dysraphism repair through a mini‐hysterotomy: Influence of gestational age at surgery on children's ability to walk

Abstract

Objective:To analyze the impact of gestational age (GA) at the time of fetal open spinal dysraphism (OSD) repair through a mini-hysterotomy on the ability of children to walk. Methods:Children who underwent in utero repair of OSD and had formal neurological assessment after 2.5 years of age were compared regarding their ability to walk in relation to pre-surgical predictors.Results: Sixty-nine children fulfilled the inclusion criteria. Among them, 63.7% (44/ 69) were able to walk with or without orthesis. Fetal OSD correction performed earlier in gestation (from 19.7 to 26.9 weeks) was associated with a higher probability of walking with or without orthesis (p = 0.033). The median GA at delivery was 35.3 weeks. Multivariate binary logistic regression showed that the upper anatomical level of the OSD (<L4 or > L5) (p < 0.004; OR: 10.31 [95% CI: 2.07-51.28]) and GA at the time of fetal surgery (p = 0.026; OR = 0.68 [95% CI: 0.48-0.95]) were independent predictors of the postnatal ability to walk with or without orthesis. Conclusion:Fetuses with OSD who were operated on earlier in pregnancy (range: 19.7-26.9 weeks), were more likely to walk with or without orthesis. Key pointsWhat is known about this topic?Children who undergo an in utero correction of an open spinal dysraphism have better neurological outcomes than those who are treated after birth � Children who undergo an in utero correction of an open spinal dysraphism at an earlier gestational age are less prone to needing postnatal ventriculoperitoneal shunts What this article adds? � Children who undergo an in utero correction of an open spinal dysraphism at an earlier gestational age have increased probability of walking with or without orthesis 1634 -Prenatal Diagnosis.

Maternal and perinatal outcomes after prenatal or postnatal surgical repair of myelomeningocele

“…The risk of prematurity was significantly greater in the prenatal group, with a greater frequency of extremely premature infants. Compared to previously reported rates for prenatal surgery, the rate found in the present study (79%) was similar to that reported for classic open surgery (74%) and for mini-hysterotomy (76.9%), but higher than rates reported for microneurosurgery (52.4%) and endoscopy (71.8%) [19,22,25].…”

“…PROM was the most important gestational complication, occurring in 48% of cases in the prenatal group. This rate is close to that of 46% described in the classic MOMS study with a uterine incision of 6.0 to 8.0 cm, but higher than that described for the mini-hysterotomy technique (28.3%), with an incision of 2.5 to 3.5 cm, and for microneurosurgery (19.0%) with an incision of 1.5 to 2.0 mm [1,18,25]. For open surgery, the risk of PROM seems lower when the uterine incision is smaller.…”

Maternal and perinatal outcomes after prenatal or postnatal surgical repair of myelomeningocele

“…The risk of prematurity was signi cantly greater in the prenatal group, with a greater frequency of extremely premature infants. Compared to previously reported rates for prenatal surgery, the rate found in the present study (79%) was similar to that reported for classic open surgery (74%) and for minihysterotomy (76.9%), but higher than rates reported for microneurosurgery (52.4%) and endoscopy (71.8%) [19,22,25].…”

“…PROM was the most important gestational complication, occurring in 48% of cases in the prenatal group. This rate is close to that of 46% described in the classic MOMS study with a uterine incision of 6.0 to 8.0 cm, but higher than that described for the mini-hysterotomy technique (28.3%), with an incision of 2.5 to 3.5 cm, and for microneurosurgery (19.0%) with an incision of 1.5 to 2.0 mm [1,18,25]. For open surgery, the risk of PROM seems lower when the uterine incision is smaller.…”