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Parental Management Choices and Discordant Ultrasound Findings in Referrals for Fetal Spina Bifida
Emma Van den Eede1,2,3, Simen Vergote1,2, Lennart Van der Veeken1,2,3
1Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
Insights
Parents opting for fetal surgery for spina bifida aperta (SBA) is high. A fetal surgery center assessment provides crucial additional information for management decisions.
Area of Science:
- Medical research
- Prenatal diagnosis
- Surgical innovation
Background:
- Prenatal ultrasound is key for assessing spina bifida aperta (SBA) severity.
- Morphological findings guide parental decisions on management options.
- The introduction of fetal surgery has impacted SBA management choices.
Purpose of the Study:
- To document parental management choices for SBA since fetal surgery became available.
- To compare initial ultrasound findings with those obtained at a fetal surgery center.
Main Methods:
- A single-center cohort study of 245 fetuses diagnosed with SBA in the second trimester.
- Data collected included referral type, ultrasound findings, and management outcomes.
- Initial ultrasound findings were compared to those at the fetal surgery center for specific indicators.
Main Results:
- 72% of fetuses were eligible for surgery, with 60% of parents choosing this option.
- Among those referred for surgery, 20% were ineligible upon further assessment.
- Key severity indicators like lesion level and leg movement were often unreported in initial referrals.
Conclusions:
- Fetal surgery uptake is substantial among eligible patients referred for surgical consultation.
- Re-evaluation at a specialized fetal surgery center frequently uncovers vital information influencing management.
Objective:
The severity of spina bifida aperta can be assessed prenatally by ultrasound. Morphological findings assist parents in choosing between management options. We aimed to document those management choices since the introduction of fetal surgery, and compare initial ultrasound findings prior to referral to findings in a fetal surgery center.
Method:
Single center cohort study of 245 consecutive fetuses with a second-trimester diagnosis of SBA. Data included nature of referral (for assessment or for surgery), condition-specific findings on ultrasound, and further management. We compared the reported findings on the initial ultrasound to ours for the presence of hindbrain herniation, lesion level, ventricular width, kyphosis, leg movement, and club feet.
Results:
Seventy-two percent (n = 177) of fetuses met the eligibility criteria for surgery; in 60% (n = 106) parents opted for fetal surgery. Of 136 patients specifically referred for surgery, 27 were ineligible (20%). Of the others, 93 proceeded with surgery. In up to 28% (n = 30) of surgery referrals, eligibility criteria such as lesion level (n = 30, 28%) or leg movement (72%, n = 78) as severity indicators were not reported.
Conclusion:
Fetal surgery uptake was high in patients referred for surgery. Second assessment in a fetal surgery center often reveals additional relevant information.
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