Parental request for non-resuscitation in fetal myelomeningocele repair: an analysis of the novel ethical tensions in fetal intervention

Wolfe, Ian; Lillegard, Joseph B.; Carter, Brian S.

doi:10.1038/s41372-022-01317-5

Cited by 4 publications

(1 citation statement)

References 31 publications

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“…Ethical principles of preserving the integrity of the unaffected twin as well as respecting the autonomy of the mother and duty to improve outcome in affected fetus were considered 11 . We agreed to proceed with the surgery after obtaining approval of our ethics committee board (reference number, CAE: 48991021.0.0000.0071), based mainly on the principle of justice for both children 12,13 . It was agreed that surgery would be performed at a later gestational age in an attempt to balance the best interests of the affected fetus and the harm threshold due to prematurity for the unaffected fetus 12,13 .…”

Section: Ethicsmentioning

confidence: 99%

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

Lapa

Acácio

Trigo

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveTwin pregnancy is currently an exclusion criterion for the prenatal repair of open spina bifida. The objective of this study was to report our experience in the treatment of twin pregnancies using the SAFER technique for repair. We also discuss the rationale of currently exclusion criteria for fetal spina bifida repair.MethodsWe have successfully repaired eight affected fetuses in seven twin pregnancies. Six were dichorionic with only one twin affected, and one was monochorionic with both twins affected. Percutaneous fetoscopy was performed under CO2 insufflation in the sac of the affected twin. Neurosurgical repair was performed using a biocellulose patch to protect the placode and skin suture to hold the patch in place, with or without a myofascial flap. Neurodevelopment was assessed by the PEDI scale in babies older than 6 months and Alberta scale below 6 months of corrected age.ResultsFourteen fetuses were liveborn, of which eight presented open spina bifida. None required any additional repair. Gestational age at surgery varied from 27.3 to 31.1 weeks and gestational age at birth varied from 31.6 to 36.0 weeks. Sequalae of prematurity was not found in any of the unaffected twins and their short‐term neurodevelopment was normal, assessed at a median chronological age of 12.5 (interquartile range, 2.7‐18.1) months. In the affected group, only one baby had a ventricle‐peritoneal shunt placed.ConclusionsPrematurity is frequent after fetal surgery, and the risk is increased in twin pregnancies. Nevertheless, prenatal surgery using the SAFER technique is feasible with low risk to both twins and their mother, when performed by a highly experienced team. Long‐term cognitive assessment of the unaffected twin is needed.This article is protected by copyright. All rights reserved.

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