Specialty-Based Variation in Applying Maternal-Fetal Surgery Trial Evidence
Ryan M Antiel1, Alan W Flake, Mark P Johnson
1University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Fetal Diagnosis and Therapy
|March 17, 2017
Summary
Most specialists view prenatal surgery for fetal myelomeningocele (MMC) favorably after the MOMS trial. Physician attitudes, influenced by specialty and risk tolerance, impact recommendations for prenatal closure and pregnancy termination.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Surgery
- Neonatology
Background:
- The Management of Myelomeningocele Study (MOMS) evaluated prenatal versus postnatal surgery for fetal myelomeningocele (MMC).
- Understanding subspecialist interpretation of MOMS trial results is crucial for clinical practice evolution.
Purpose of the Study:
- To assess how maternal-fetal medicine (MFM) physicians, neonatologists, and pediatric surgeons interpret the MOMS trial findings.
- To determine if these interpretations have influenced clinical practice regarding fetal myelomeningocele management.
Main Methods:
- A cross-sectional survey was mailed to 1,200 randomly selected MFM physicians, neonatologists, and pediatric surgeons.
- Response rate was 57% (670 out of 1,176 eligible physicians).
Main Results:
- A significant majority viewed prenatal closure favorably (33% "very favorable", 60% "somewhat favorable").
- Most physicians were more likely to recommend prenatal surgery (69%) and less likely to recommend termination (28%).
- Neonatologists and pediatric surgeons showed stronger preferences for prenatal closure and less inclination towards termination, with variations linked to prematurity tolerance.
Conclusions:
- Pediatric subspecialists and MFMs generally hold favorable views on prenatal myelomeningocele closure post-MOMS trial.
- Specialty and individual risk tolerance significantly influence these attitudes and clinical recommendations.
