Prenatal Diagnosis and Patient Preferences in Patients with Neural Tube Defects around the Advent of Fetal Surgery in Belgium and Holland

Ovaere, Céline; Eggink, Alex J.; Richter, Jute; Cohen–Overbeek, Titia E.; Calenbergh, Frank Van; Jansen, Katrien; Oepkes, Dick; Devlieger, Roland; Catte, Luc De; Deprest, Jan

doi:10.1159/000365214

Cited by 36 publications

(40 citation statements)

References 39 publications

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“…Actual uptake of fMMC surgery amongst eligible cases was 18% when it required a cross‐border referral but increased to 75% when the intervention became available locally. The latter number is much higher than that reported by Ovaere et al and by Mazzone et al in two European cohort studies, where only six of 14 (42.8%) eligible patients and 56 of 106 (53%) eligible patients, respectively, underwent the intervention. It is also higher than the numbers reported by Moldenhauer et al in the United States after the MOMS trial, where only 29% of those eligible for surgery underwent the procedure.…”

Section: Discussioncontrasting

confidence: 54%

Fetal myelomeningocele surgery: Only treating the tip of the iceberg

et al. 2018

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Objective Fetal myelomeningocele (fMMC) surgery improves infant outcomes when compared with postnatal surgery. Surgical selection criteria and the option of pregnancy termination, however, limit the number of cases that are eligible for prenatal surgery. We aimed to quantify what proportion of cases could ultimately benefit from fetal therapy. Methods We retrospectively reviewed all cases of fMMC referred to a large tertiary care center over a 10‐year period and assessed their eligibility for fetal surgery, pregnancy termination rates, and actual uptake of the surgery. Results Of 158 cases, 67 (42%) were ineligible for fetal surgery based on surgical exclusion criteria. Eleven fetuses (7%) had chromosomal anomalies, 10 of which (91%) had other anomalies on ultrasound. Thirty‐four patients had a combination of maternal and fetal contraindications. Of the remaining 91 eligible cases (58%), 45 (49%) pregnancies were terminated, leaving only 46 (29% of initial 158 cases) as potential candidates for fetal repair. Actual uptake of fetal surgery was 15% (n = 14 of 91), but this increased after a national program was started. Conclusion Only a minority of fMMC cases will ultimately undergo fetal surgery. These numbers support the centralization of care in expert centers.

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Section: Discussioncontrasting

confidence: 54%

Fetal myelomeningocele surgery: Only treating the tip of the iceberg

et al. 2018

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“…A European center recently reported that 76% of prenatal diagnoses of spina bifida resulted in termination, and the authors found that requests were not correlated with the severity of disease [32] . The results of the MOMS trial may modify this number as perceptions surrounding open maternal-fetal surgery change.…”

Section: Discussionmentioning

confidence: 99%

Specialty-Based Variation in Applying Maternal-Fetal Surgery Trial Evidence

Antiel¹,

Flake

Johnson

et al. 2017

Fetal Diagn Ther

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Introduction: The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for fetal myelomeningocele (MMC). We sought to understand how subspecialists interpreted the trial results and whether their practice has changed. Materials and Methods: Cross-sectional, mailed survey of 1,200 randomly selected maternal-fetal medicine (MFM) physicians, neonatologists, and pediatric surgeons. Results: Of 1,176 eligible physicians, 670 (57%) responded. Compared to postnatal closure, 33% viewed prenatal closure as “very favorable” and 60% as “somewhat favorable.” Most physicians reported being more likely to recommend prenatal surgery (69%), while 28% were less likely to recommend pregnancy termination. In multivariable analysis, neonatologists were more likely to report prenatal closure as “very favorable” (OR 1.6; 95% CI: 1.03-2.5). Pediatric surgeons and neonatologists were more likely to recommend prenatal closure (OR 2.1; 95% CI: 1.3-3.3, and OR 2.9; 95% CI: 1.8-4.6) and less likely to recommend termination (OR 3.8; 95% CI: 2.2-6.7, and OR 4.7; 95% CI: 2.7-8.1). In addition, physicians with a higher tolerance for prematurity were more likely to report prenatal closure as “very favorable” (OR 1.02; 95% CI: 1.00-1.05). Discussion: In light of the MOMS trial, the vast majority of pediatric subspecialists and MFMs view prenatal MMC closure favorably. These attitudes vary by specialty and risk tolerance.

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“…Moreover, the cultural characteristics of Brazilian women, who are more tolerant of open surgeries such as cesarean sections, allow the performance of a higher number of open surgeries for intrauterine MMC repair. These cultural characteristics are different from those of European women [21]. …”

Section: Discussionmentioning

confidence: 99%

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Santana¹,

Moron²,

Barbosa³

et al. 2015

Fetal Diagn Ther

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Objective: The aim of this study was to assess fetal hemodynamics during intrauterine open surgery for myelomeningocele (MMC) repair by describing fetal heart rate (FHR) monitoring in detail related to each part of the procedure. Methods: A study was performed with 57 fetuses submitted to intrauterine MMC repair between the 24th and 27th week of gestation. Evaluations of FHR were made in specific periods: before anesthesia, after anesthesia, at the beginning of laparotomy, during uterus abdominal withdrawal, hysterotomy, neurosurgery (before incision, during early skin manipulation, spinal cord releasing, and at the end of neurosurgery), abdominal cavity reintroduction, and abdominal closure, and at the end of surgery. Means ± standard deviations of FHR were established for each period, and analysis of variance with repeated measures was used to assess differences between these periods. The mean differences were assessed with 95% confidence intervals and were analyzed by Tukey's multiple comparison test. Results: The mean FHR during the specific periods mentioned above was 140.2, 140, 139.2, 138.8, 135.1, 133.9, 123.1, 134.0, 134.5, 137.9, and 139.9 bpm, respectively (p < 0.0001). Comparing the different periods, the highest frequencies were observed in the initial and final moments. The neurosurgery stage presents lower frequencies, especially during the release of the spinal cord. Conclusion: FHR monitoring revealed interesting findings in terms of physiological fetal changes during MMC repair, especially during neurosurgery, which was the most critical period.

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Prenatal Diagnosis and Patient Preferences in Patients with Neural Tube Defects around the Advent of Fetal Surgery in Belgium and Holland

Cited by 36 publications

References 39 publications

Fetal myelomeningocele surgery: Only treating the tip of the iceberg

Fetal myelomeningocele surgery: Only treating the tip of the iceberg

Specialty-Based Variation in Applying Maternal-Fetal Surgery Trial Evidence

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

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