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Fetal surgery for open spina bifida.

Adalina Sacco1, Fred Ushakov2, Dominic Thompson3

  • 1Clinical Research Fellow, Fetal Medicine Unit Elizabeth Garrett Anderson Wing University College London Hospital NHS Foundation Trust 235 Euston Road London NW1 2BU UK.

The Obstetrician & Gynaecologist : the Journal for Continuing Professional Development From the Royal College of Obstetricians & Gynaecologists
|December 3, 2019
PubMed
Summary

Open fetal repair for spina bifida improves outcomes for the child, including mobility and bladder function. While prematurity is a risk, this prenatal surgery does not appear to worsen neurodevelopmental impairment.

Keywords:
fetal surgeryfetoscopymyelomeningoceleprenatalspina bifida

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Area of Science:

  • Neurology
  • Fetal Surgery
  • Congenital Abnormalities

Background:

  • Spina bifida is a congenital neurological condition with significant lifelong physical and mental effects.
  • Prenatal diagnosis and understanding clinical effects are crucial for management.
  • Open fetal repair has emerged as a potential intervention.

Purpose of the Study:

  • To review the clinical effects, prevention, and prenatal diagnosis of spina bifida.
  • To evaluate the evidence for benefits and risks of open fetal repair.
  • To define criteria for patient selection for fetal surgery.

Main Methods:

  • Review of existing literature on open fetal repair for spina bifida.
  • Analysis of outcomes related to hindbrain herniation, shunting, mobility, and bladder function.
  • Consideration of maternal morbidity and neurodevelopmental outcomes.

Main Results:

  • Open fetal repair improves key outcomes like hindbrain herniation, need for shunting, mobility, and bladder function.
  • Prematurity is an increased risk, but neurodevelopmental impairment is not exacerbated.
  • Maternal morbidity is a significant consideration associated with the procedure.

Conclusions:

  • Open fetal surgery for spina bifida offers significant benefits for the child's outcomes.
  • Careful patient selection based on established criteria is essential.
  • Further research on long-term outcomes, fetoscopic repair, and alternative techniques is needed.