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Observational Study
. 2019 May;220(5):494.e1-494.e7.
doi: 10.1016/j.ajog.2019.03.008. Epub 2019 Mar 15.

Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele

William H Goodnight  1 , Ozan Bahtiyar  2 , Kelly A Bennett  3 , Stephen P Emery  4 , J B Lillegard  5 , Allan Fisher  6 , Ruth Goldstein  7 , Jillian Jatres  8 , Foong-Yen Lim  9 , Laurence McCullough  10 , Ueli Moehrlen  11 , Julie S Moldenhauer  8 , Anita J Moon-Grady  7 , Rodrigo Ruano  12 , Daniel W Skupski  13 , Elizabeth Thom  14 , Marjorie C Treadwell  15 , KuoJen Tsao  16 , Amy J Wagner  17 , Lindsay N Waqar  8 , Michael Zaretsky  18 ; fMMC Consortium sponsored by NAFTNet
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Observational Study

Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele

William H Goodnight et al. Am J Obstet Gynecol. 2019 May.

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.

Keywords: cesarean delivery; fMMC; fetal myelomeningocele; fetal myelomeningocele repair; fetal surgery; myelomeningocele; open maternal fetal surgery; spina bifida; uterine rupture.

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Figure 1:
Pregnancy subsequent to OMFS for fetal MMC
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References

    1. Adzick NS, Thom EA, Spong CY, Brock JW, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N,Tulipan NB, D’Alton ME, Farmer DL, MOMS Investigators A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med, 2011. 364(11): p. 993–1004. - PMC - PubMed
    1. Landon MA, Lynch CD, Optimal timing and mode of delivery after cesarean with previous classical incision or myomectomy; a review of the data. Seminars in Perinatology, 2011. 35: p. 257–261. - PubMed
    1. Chauhan SP, Magann EF, Wiggs CD, Barrilleaux PS, Martin JN Jr., Pregnancy after classic cesarean delivery. Obstet Gynecol, 2002. 100(5 Pt 1): p. 946–50. - PubMed
    1. Wilson RD, Lemerand K, Johnson MP, Flake AW, Bebbington M, Hedrick HL, Adzick NS, Reproductive outcomes in subsequent pregnancies after a pregnancy complicated by open maternal-fetal surgery (1996–2007). Am J Obstet Gynecol, 2010. 203(3): p. 209.e1–6. - PubMed
    1. Zamora IJ, Ethun CG, Evans LM, Olutoye OO, Ivey RT,Haeri S,Belfort MA,Lee TC,Cass DL, Maternal morbidity and reproductive outcomes related to fetal surgery. J Pediatr Surg, 2013. 48(5): p. 951–5. - PubMed

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