Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele

Goodnight, William; Bahtiyar, Mert O.; Bennett, Kelly; Emery, Stephen P.; Lillegard, Joseph B.; Fisher, Allan J.; Goldstein, Ruth B.; Jatres, Jillian; Lim, Foong‐Yen; McCullough, Laurence B.; Moehrlen, Ueli; Moldenhauer, Julie S.; Moon-Grady, Anita J.; Ruano, Rodrigo; Skupski, Daniel; Thom, Elizabeth; Treadwell, Marjorie C.; Tsao, KuoJen; Wagner, Amy J.; Waqar, Lindsay N.; Zaretsky, Michael V.

doi:10.1016/j.ajog.2019.03.008

Cited by 67 publications

(64 citation statements)

References 24 publications

(19 reference statements)

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“…The live born rate for those progressing beyond 20 weeks was 96.2% and median gestational age at delivery was 37 weeks. Nevertheless, the risk of uterine dehiscence/thinning (17.3%) and uterine rupture in subsequent pregnancies was significant (9.6%) and resulted in a fetal death prevalence of nearly 4% …”

Section: Maternal Outcomesmentioning

confidence: 96%

Fetal surgical intervention for myelomeningocele: lessons learned, outcomes, and future implications

Danzer

Joyeux

Flake

et al. 2019

Develop Med Child Neuro

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Fetal myelomeningocele (fMMC) closure (spina bifida aperta) has become a care option for patients that meet inclusion criteria, but it is clear that fetal intervention, while improving outcomes, is not a cure. This review will: (1) focus on the rationale for fMMC surgery based on preclinical studies and observations that laid the foundation for human pilot studies and a randomized controlled trial; (2) summarize important clinical outcomes; (3) discuss the feasibility, efficacy, and safety of recent developments in fetal surgical techniques and approaches; and (4) highlight future research directions. Given the increased risk of maternal and fetal morbidity associated with prenatal intervention, accompanied by the increasing number of centres performing interventions worldwide, teams involved in the care of these patients need to proceed with caution to maintain technical expertise, competency, and patient safety. Ongoing assessment of durability of the benefits of fMMC surgery, as well as additional refinement of patient selection criteria and counselling, is needed to further improve outcomes and reduce the risks to the mother and fetus. What this paper adds High‐quality prospective studies are needed to broaden the indication for fetal surgery in the general myelomeningocele population. Innovative minimally invasive approaches have had promising results, yet lack comprehensive and robust experimental or clinical evaluation. Important information to help families make informed decisions regarding fetal surgery for myelomeningocele is provided.

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Section: Maternal Outcomesmentioning

confidence: 96%

Fetal surgical intervention for myelomeningocele: lessons learned, outcomes, and future implications

Danzer

Joyeux

Flake

et al. 2019

Develop Med Child Neuro

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“…Fetal therapy contributes significantly to the literature, and this year we highlight maternal issues as well as technological developments that could enhance our ability to deliver in‐utero therapy. In 2019, two papers described the potential maternal complications of fetal surgery . The first was a systematic review of 166 studies reporting either open or endoscopic in‐utero surgery.…”

Section: Advances In Fetal Theraphymentioning

confidence: 99%

“…This is in contrast to the second study that reported maternal outcomes for 77 women undergoing hysterotomy for fetal spina bifida repair. Here they showed that the risk for rupture (9.6%) and perinatal death was similar to that seen after classical caesarean section . This is an important driver in the further development of endoscopic techniques.…”

Section: Advances In Fetal Theraphymentioning

confidence: 99%

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2019

et al. 2020

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“…However, despite its beneficial effects, open prenatal SBR as it is performed today is less than perfect. Not only is it associated with maternal and fetal risks (Adzick et al, ; Goodnight et al, ; Johnson et al, ), but also results are not consistent. Therefore, future improvements, especially regarding operation techniques and timing, are warranted.…”

Section: Introductionmentioning

confidence: 99%

Bioengineering and in utero transplantation of fetal skin in the sheep model: A crucial step towards clinical application in human fetal spina bifida repair

Mazzone

Moehrlen

Ochsenbein‐Kölble

et al. 2019

J Tissue Eng Regen Med

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An intricate problem during open human fetal surgery for spina bifida regards back skin closure, particularly in those cases where the skin defect is much too large for primary closure. We hypothesize that tissue engineering of fetal skin might provide an adequate autologous skin substitute for in utero application in such situations. Eight sheep fetuses of four time-mated ewes underwent fetoscopic skin biopsy at 65 days of gestation. Fibroblasts and keratinocytes isolated from the biopsy were used to create fetal dermo-epidermal skin substitutes. These were transplanted on the fetuses by open fetal surgery at 90 days of gestation on skin defects (excisional wounds) created during the same procedure. Pregnancy was allowed to continue until euthanasia at 120 days of gestation. The graft area was analyzed macroscopically and microscopically. The transplanted fetal dermo-epidermal skin substitutes was well discernable in situ in three of the four fetuses available for analysis. Histology confirmed healed grafts with a close to natural histological skin architecture four weeks after in utero transplantation. This experimental study generates evidence that laboratory grown autologous fetal skin analogues can successfully be transplanted in utero. These results have clinical implications as an analogous procedure might be applied in human fetuses undergoing prenatal repair to facilitate primary skin closure. Finally, this study may also fertilize the field of fetal tissue engineering in general, particularly when more interventional, minimallyinvasive, and open fetal surgical procedures become available.

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Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele

Cited by 67 publications

References 24 publications

Fetal surgical intervention for myelomeningocele: lessons learned, outcomes, and future implications

Fetal surgical intervention for myelomeningocele: lessons learned, outcomes, and future implications

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2019

Bioengineering and in utero transplantation of fetal skin in the sheep model: A crucial step towards clinical application in human fetal spina bifida repair

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