Risk Factors for Preterm Birth following Open Fetal Myelomeningocele Repair: Results from a Prospective Cohort

Abstract

<b><i>Background:</i></b> Fetal myelomeningocele (fMMC) repair is a therapeutic option in selected cases. This study aimed to identify risk factors for preterm birth (PTB) following open fMMC repair. <b><i>Methods:</i></b> Sixty-seven women underwent fMMC repair and delivered a baby between 2010 and 2018 at our center. Demographic, surgical, and pregnancy complications, including potential risk factors for PTB such as preterm premature rupture of membranes (PPROM), chorioamniotic membrane separation (CMS), and placental abruption were evaluated. <b><i>Results:</i></b> Maternal body mass index, maternal age, parity, previous uterine surgery, gestational age at fetal surgery, total surgery duration, surgical subcutaneous hematoma, oligohydramnios, and amniotic fluid leakage were not identified as risk factors for PTB. CMS (<i>p</i> = 0.028, 92 vs. 52%) and PPROM (<i>p</i> = 0.001, 95 vs. 52%) were highly associated with PTB. Placental abruption was found more often in women after fMMC repair than in a general obstetrical population (12 vs. 1%) and ended in premature birth in all cases (<i>p</i> = 0.024, 100 vs. 60%). However, the majority of women delivered at a gestational age >35 weeks. <b><i>Conclusions:</i></b> In our study cohort, risk factors for PTB were PPROM, CMS, and placental abruption, whereas surgery duration did not influence outcome. We conclude that the surgery technique should aim to minimize CMS and amniotic fluid leakage.

Myelomeningocele Surgery over the 10 Years Following the MOMS Trial: A Systematic Review of Outcomes in Prenatal versus Postnatal Surgical Repair

“…The remaining 112 were assessed for eligibility by full-text reading. The selection left us with 27 eligible articles that were included in the study ( Figure 1 ) [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

“…Table 2 summarizes the maternal outcomes after prenatal interventions as reported in different studies. Two studies with early experience (defined as less than 30 patients) reported placental abruption rates of 10% [ 28 ] and 0% [ 23 ] whereas studies including more than 30 patients reported an average rate of placental abruption of 5.9% [ 17 , 19 , 24 , 25 ]. Only two studies, both having late experience, reported pulmonary edema rates of 2% [ 24 ] and 2.98% [ 17 ], respectively.…”

“…Two studies with early experience (defined as less than 30 patients) reported placental abruption rates of 10% [ 28 ] and 0% [ 23 ] whereas studies including more than 30 patients reported an average rate of placental abruption of 5.9% [ 17 , 19 , 24 , 25 ]. Only two studies, both having late experience, reported pulmonary edema rates of 2% [ 24 ] and 2.98% [ 17 ], respectively. Two series, both including more than 30 patients, reported chorioamnionitis rates of 4% [ 24 ] and 2.95% [ 25 ].…”

“…Two series, both including more than 30 patients, reported chorioamnionitis rates of 4% [ 24 ] and 2.95% [ 25 ]. PPROM seemed to be less frequent in late experience versus early experience studies ( p < 0.01) [ 13 , 17 , 19 , 23 , 24 , 25 , 28 ]. Comparing fetoscopic and open techniques, an average rate of placental abruption of 9.41% was reported in fetoscopic series [ 19 , 28 ] and of 3.69% in series using open techniques, respectively.…”

“…Comparing fetoscopic and open techniques, an average rate of placental abruption of 9.41% was reported in fetoscopic series [ 19 , 28 ] and of 3.69% in series using open techniques, respectively. The average rate of PPROM in series using fetoscopic techniques was 63.23% [ 17 , 28 ] and 30.71% in open surgery series [ 17 , 23 , 24 , 25 ].…”