Maternal Complications following Open Fetal Myelomeningocele Repair at the Zurich Center for Fetal Diagnosis and Therapy

Winder, Franziska; Vonzun, Ladina; Meuli, Martin; Moehrlen, Ueli; Mazzone, Luca; Krähenmann, Franziska; Hüsler, M; Zimmermann, Roland; Ochsenbein‐Kölble, Nicole

doi:10.1159/000494024

Cited by 22 publications

(21 citation statements)

References 24 publications

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“…Intrauterine repair of OSB is a complex maternal-fetal intervention associated with severe perinatal complications. Although maternal safety is a major concern of any open fetal surgery, clinical experience has shown that this procedure is associated with a low rate of serious maternal complications [15, 16]. In our series, no maternal deaths or serious intraoperative or postoperative maternal complications were noted.…”

Section: Discussionmentioning

confidence: 55%

Prenatal Repair of Spina Bifida: A 2-Center Experience with Open Intrauterine Neurosurgery in Chile

et al. 2020

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Objective: To report the experience with prenatal repair of open spina bifida (OSB) from 2 centers in Chile. Methods: Women with a second-trimester fetus with OSB were offered intrauterine neurosurgical repair following the protocol from the Management of Myelomeningocele Study (MOMS) trial. Pediatric follow-up with infants reaching 12 and 30 months of life was also reviewed. Results: Fifty-eight fetuses with OSB underwent intrauterine repair at an average (±SD) gestational age of 24.8 ± 0.9 weeks. There were 3 (5.1%) intrauterine deaths. The average gestational age at delivery of the remaining 55 cases was 33.3 ± 3.6 weeks, and the average birth weight was 2,172 ± 751 g. Delivery before 30 weeks occurred in 11 cases (20.0%). Two (3.6%) neonatal deaths (<28 days) occurred. At 12 months, a ventriculoperitoneal shunt or an endoscopic third ventriculostomy was required in 25% of the cases. At 30 months, 72.4% of the infants were able to walk. Discussion: Prenatal neurosurgical repair of OSB is a complex and challenging intervention. Major complications include perinatal death and severe prematurity. No major maternal complications occurred in our series. A reduction in the need for cerebrospinal fluid diversion and an improved ability to walk seem to be the greatest longterm advantages of this procedure.

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Section: Discussionmentioning

confidence: 55%

Prenatal Repair of Spina Bifida: A 2-Center Experience with Open Intrauterine Neurosurgery in Chile

et al. 2020

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“…Therefore, parental counselling must highlight the delicate balance between potential outcome benefits and risks for mother and fetus following open fMMC repair. To obtain a basis for counselling, we applied a systematic classification of maternal risks after fMMC repair according to a well‐established therapy‐oriented classification of surgical complications by Clavien–Dindo in 2018 on our first 40 cases 7 . Additionally, a large systematic review and meta‐analysis of maternal complications following open fMMC repair was published recently 8 .…”

Section: Introductionmentioning

confidence: 99%

Systematic classification of maternal and fetal intervention‐related complications following open fetal myelomeningocele repair – results from a large prospective cohort

Vonzun

Kahr

Noll

et al. 2020

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Objective To systematically categorise all maternal and fetal intervention‐related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. Design A prospective cohort study. Setting Single centre. Population Mothers and fetuses after fMMC repair. Methods Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien–Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. Main outcome measures Systematic classification of maternal and fetal complications following fMMC repair. Results Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention‐related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. Conclusion This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. Tweetable abstract Systematic classification of all maternal and fetal intervention‐related complications following open fMMC repair.

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“…Since fetal intervention is associated with significant investment [12] and certain risks for the mother and fetus [13,14], it seems crucial to identify factors indicating the risk of shunt placement during the infant's first year of life. We could show in a previous study that ventricle width plays an important predictive role for the necessity of shunt placement [15].…”

Section: Introductionmentioning

confidence: 99%

Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair – When Do These Signs Disappear and is Shunting Predictable?

et al. 2020

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Purpose The aim was to describe the sonographic follow-up of hindbrain herniation (HH), the banana and lemon sign after fetal myelomeningocele (fMMC) repair, and the time of disappearance of these signs after the intervention, and to investigate any predictive value for the necessity of shunting during the infant’s first year of life. Additionally, the sonographic evolution of the transcerebellar diameter (TCD) before and after fetal intervention was assessed. Patients and Methods The first 50 patients that underwent fMMC repair at Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch) were included in this study. Sonographic scans performed weekly after fMMC repair focusing on HH and banana and lemon signs were analyzed and compared between the shunted and the non-shunted group. ROC curves were generated for the time intervals of resolution of the signs in order to show their predictive accuracy for the need for shunting until 1 year of age. Results HH resolved in 48 fetuses (96 %) before delivery. The sonographic disappearance of HH within the first two weeks after fMMC repair was associated with a significantly lower incidence of shunt placement (OR 0.19; 95 % CI 0.4–0.9) during the first year of life (p = 0.03). All fetuses with persistent HH before delivery received a shunt. TCD growth was observed in all fetuses. Conclusion The reversibility of HH within two weeks after fMMC repair is associated with an 80 % lower incidence of shunt placement during the infant’s first year of life. Moreover, it allows the cerebellum to grow and to normalize its configuration.

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Maternal Complications following Open Fetal Myelomeningocele Repair at the Zurich Center for Fetal Diagnosis and Therapy

Cited by 22 publications

References 24 publications

Prenatal Repair of Spina Bifida: A 2-Center Experience with Open Intrauterine Neurosurgery in Chile

Prenatal Repair of Spina Bifida: A 2-Center Experience with Open Intrauterine Neurosurgery in Chile

Systematic classification of maternal and fetal intervention‐related complications following open fetal myelomeningocele repair – results from a large prospective cohort

Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair – When Do These Signs Disappear and is Shunting Predictable?

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