William H Goodnight1, Ozan Bahtiyar2, Kelly A Bennett3, Stephen P Emery4, J B Lillegard5, Allan Fisher6, Ruth Goldstein7, Jillian Jatres8, Foong-Yen Lim9, Laurence McCullough10, Ueli Moehrlen11, Julie S Moldenhauer8, Anita J Moon-Grady7, Rodrigo Ruano12, Daniel W Skupski13, Elizabeth Thom14, Marjorie C Treadwell15, KuoJen Tsao16, Amy J Wagner17, Lindsay N Waqar8, Michael Zaretsky18. 1. University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: william_goodnight@med.unc.edu. 2. Yale University, New Haven, CT. 3. Vanderbilt University, Nashville, TN. 4. University of Pittsburgh, Pittsburgh, PA. 5. Midwest Fetal Care Center, Children's Hospital of Minnesota, Minneapolis, MN. 6. St Louis University, St Louis, MO. 7. University of California San Francisco, San Francisco, CA. 8. Children's Hospital of Philadelphia, Philadelphia, PA. 9. Cincinnati Children's Hospital, Cincinnati, OH. 10. Baylor College of Medicine, Houston, TX. 11. Children's Hospital Zurich, Zurich, Switzerland. 12. Mayo Clinic, Rochester, MN. 13. Cornell University, New York, NY. 14. George Washington University, Bethesda, MD. 15. University of Michigan, Ann Arbor, MI. 16. University of Texas Health Center, Houston, TX. 17. Children's Hospital of Wisconsin Fetal Concerns Center, Milwaukee, WI. 18. Colorado Fetal Care Center, Denver, CO.
Abstract
BACKGROUND: Open maternal-fetal surgery for fetal myelomeningocele results in reduction in neonatal morbidity related to spina bifida but may be associated with fetal, neonatal, and maternal complications in subsequent pregnancies. OBJECTIVE: The objective of this study was to ascertain obstetric risk in subsequent pregnancies after open maternal-fetal surgery for fetal myelomeningocele closure. STUDY DESIGN: An international multicenter prospective observational registry created to track and report maternal, obstetric, fetal/neonatal, and subsequent pregnancy outcomes following open maternal-fetal surgery for fetal myelomeningocele was evaluated for subsequent pregnancy outcome variables. Institutional Review Board approval was obtained for the registry. RESULTS: From 693 cases of open maternal-fetal surgery for fetal myelomeningocele closure entered into the registry, 77 subsequent pregnancies in 60 women were identified. The overall live birth rate was 96.2%, with 52 pregnancies delivering beyond 20 weeks gestational age and median gestational age at delivery of 37 (36.3-37.1) weeks. The uterine rupture rate was 9.6% (n = 5), resulting in 2 fetal deaths. Maternal transfusion was required in 4 patients (7.7%). CONCLUSION: The risk of uterine rupture or dehiscence in subsequent pregnancies with associated fetal morbidity after open maternal-fetal surgery is significant, but is similar to that reported for subsequent pregnancies after classical cesarean deliveries. Future pregnancy considerations should be included in initial counseling for women contemplating open maternal-fetal surgery.
BACKGROUND: Open maternal-fetal surgery for fetal myelomeningocele results in reduction in neonatal morbidity related to spina bifida but may be associated with fetal, neonatal, and maternal complications in subsequent pregnancies. OBJECTIVE: The objective of this study was to ascertain obstetric risk in subsequent pregnancies after open maternal-fetal surgery for fetal myelomeningocele closure. STUDY DESIGN: An international multicenter prospective observational registry created to track and report maternal, obstetric, fetal/neonatal, and subsequent pregnancy outcomes following open maternal-fetal surgery for fetal myelomeningocele was evaluated for subsequent pregnancy outcome variables. Institutional Review Board approval was obtained for the registry. RESULTS: From 693 cases of open maternal-fetal surgery for fetal myelomeningocele closure entered into the registry, 77 subsequent pregnancies in 60 women were identified. The overall live birth rate was 96.2%, with 52 pregnancies delivering beyond 20 weeks gestational age and median gestational age at delivery of 37 (36.3-37.1) weeks. The uterine rupture rate was 9.6% (n = 5), resulting in 2 fetal deaths. Maternal transfusion was required in 4 patients (7.7%). CONCLUSION: The risk of uterine rupture or dehiscence in subsequent pregnancies with associated fetal morbidity after open maternal-fetal surgery is significant, but is similar to that reported for subsequent pregnancies after classical cesarean deliveries. Future pregnancy considerations should be included in initial counseling for women contemplating open maternal-fetal surgery.
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