Cleisson F A Peralta1,2,3,4, Rafael D Botelho1,2,3, Edson R Romano5, Vanessa Imada6,7, Fabrício Lamis6,7, Ronaldo R Júnior8, Fernando Nani9, Gerd H Stoeber10, Antônio A F de Salles6,7,11. 1. Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil. 2. Fetal Medicine Unit, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil. 3. Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil. 4. Fetal Medicine Unit, CETRUS - São Paulo Ultrasound Training Center, São Paulo, Brazil. 5. Intensive Care Unit, HCor Hospital do Coração, São Paulo, Brazil. 6. Department of Neuroscience, HCor Hospital do Coração, São Paulo, Brazil. 7. Department of Neurosurgery, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil. 8. Department of Anesthesiology, HCor Hospital do Coração, São Paulo, Brazil. 9. Department of Anesthesiology, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil. 10. Intensive Care Unit, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil. 11. Department of Neurosurgery, University of California, Los Angeles, California, USA.
Abstract
OBJECTIVE: To analyze the impact of gestational age (GA) at the time of fetal open spinal dysraphism (OSD) repair through a mini-hysterotomy on the perinatal outcomes and the infants' ventriculoperitoneal shunt rates. METHODS: Retrospective study of cases of fetal OSD correction performed from 2014 and 2019. RESULTS: One hundred and ninety women underwent fetal surgery for OSD through a mini-hysterotomy, and 176 (176/190:92.6%) have since delivered. Fetal OSD correction performed earlier in the gestational period, ranging from 19.7 to 26.9 weeks, was associated with lower rates of postnatal ventriculoperitoneal shunting (P: .049). Earlier fetal surgeries were associated with shorter surgical times (P: .01), smaller hysterotomy lengths (P < .001), higher frequencies of hindbrain herniation reversal (P: .003), and longer latencies from surgery to delivery (P < .001). Median GA at delivery was 35.3 weeks. Multivariate binary logistic regression showed that both fetal lateral ventricle-to-hemisphere ratio (%; P < .001; OR: 1.14 [95% CI: 1.09-1.21]) and GA at the time of fetal surgery (P: .016; OR: 1.37 [95% CI: 1.07-1.77]) were independent predictors of postnatal ventriculoperitoneal shunting. CONCLUSION: Fetuses with OSD who were operated on earlier in the gestational interval, which ranged from 19.7 to 26.9 weeks, were less prone to receiving postnatal ventriculoperitoneal shunts.
OBJECTIVE: To analyze the impact of gestational age (GA) at the time of fetal open spinal dysraphism (OSD) repair through a mini-hysterotomy on the perinatal outcomes and the infants' ventriculoperitoneal shunt rates. METHODS: Retrospective study of cases of fetal OSD correction performed from 2014 and 2019. RESULTS: One hundred and ninety women underwent fetal surgery for OSD through a mini-hysterotomy, and 176 (176/190:92.6%) have since delivered. Fetal OSD correction performed earlier in the gestational period, ranging from 19.7 to 26.9 weeks, was associated with lower rates of postnatal ventriculoperitoneal shunting (P: .049). Earlier fetal surgeries were associated with shorter surgical times (P: .01), smaller hysterotomy lengths (P < .001), higher frequencies of hindbrain herniation reversal (P: .003), and longer latencies from surgery to delivery (P < .001). Median GA at delivery was 35.3 weeks. Multivariate binary logistic regression showed that both fetal lateral ventricle-to-hemisphere ratio (%; P < .001; OR: 1.14 [95% CI: 1.09-1.21]) and GA at the time of fetal surgery (P: .016; OR: 1.37 [95% CI: 1.07-1.77]) were independent predictors of postnatal ventriculoperitoneal shunting. CONCLUSION: Fetuses with OSD who were operated on earlier in the gestational interval, which ranged from 19.7 to 26.9 weeks, were less prone to receiving postnatal ventriculoperitoneal shunts.
Authors: Jan Deprest; Marc Van Ranst; Lore Lannoo; Emma Bredaki; Greg Ryan; Anna David; Jute Richter; Tim Van Mieghem Journal: Prenat Diagn Date: 2020-04-22 Impact factor: 3.242
Authors: Y Kunpalin; J Richter; N Mufti; J Bosteels; S Ourselin; P De Coppi; D Thompson; A L David; J Deprest Journal: BJOG Date: 2021-01 Impact factor: 7.331