Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele

被引：75

作者：

Goodnight, William H. ^{[1
]}

Bahtiyar, Ozan ^{[2
]}

Bennett, Kelly A. ^{[3
]}

Emery, Stephen P. ^{[4
]}

Lillegard, J. B. ^{[5
]}

Fisher, Allan ^{[6
]}

Goldstein, Ruth ^{[7
]}

Jatres, Jillian ^{[8
]}

Lim, Foong-Yen ^{[9
]}

McCullough, Laurence ^{[10
]}

Moehrlen, Ueli ^{[11
]}

Moldenhauer, Julie S. ^{[8
]}

Moon-Grady, Anita J. ^{[7
]}

Ruano, Rodrigo ^{[12
]}

Skupski, Daniel W. ^{[13
]}

Thom, Elizabeth ^{[14
]}

Treadwell, Marjorie C. ^{[15
]}

Tsao, Kuojen ^{[16
]}

Wagner, Amy J. ^{[17
]}

Waqar, Lindsay N. ^{[8
]}

Zaretsky, Michael ^{[18
]}

机构：

[1] Univ N Carolina, Chapel Hill, NC 27515 USA

[2] Yale Univ, New Haven, CT USA

[3] Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA

[4] Univ Pittsburgh, Pittsburgh, PA USA

[5] Childrens Hosp Minnesota, Midwest Fetal Care Ctr, Minneapolis, MN USA

[6] St Louis Univ, St Louis, MO 63103 USA

[7] Univ Calif San Francisco, San Francisco, CA 94143 USA

[8] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[9] Cincinnati Childrens Hosp, Cincinnati, OH USA

[10] Baylor Coll Med, Houston, TX 77030 USA

[11] Childrens Hosp Zurich, Zurich, Switzerland

[12] Mayo Clin, Rochester, MN USA

[13] Cornell Univ, New York, NY 10021 USA

[14] George Washington Univ, Bethesda, MD USA

[15] Univ Michigan, Ann Arbor, MI 48109 USA

[16] Univ Texas Houston, Hlth Ctr, Houston, TX USA

[17] Childrens Hosp Wisconsin, Fetal Concerns Ctr, Milwaukee, WI 53201 USA

[18] Colorado Fetal Care Ctr, Denver, CO USA

来源：

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY | 2019年 / 220卷 / 05期

关键词：

cesarean delivery; fetal myelomeningocele; fetal myelomeningocele repair; fetal surgery; fMMC; myelomeningocele; open maternal fetal surgery; spina bifida; uterine rupture; MORBIDITY; DELIVERY; TERM;

D O I：

10.1016/j.ajog.2019.03.008

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

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.

引用

页码：494.e1 / 494.e7

页数：7

共 22 条

[1] A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele [J].