Current Selection Criteria and Perioperative Therapy Used for Fetal Myelomeningocele Surgery

Kenneth J. Moise, Julie S. Moldenhauer, Kelly A. Bennett, William Goodnight, Francois I. Luks, Stephen P. Emery, Kuojen Tsao, Anita J. Moon, R. Clifton Moore, Marjorie C. Treadwell, Emanuel J. Vlastos, Nicholas M. Wetjen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: To determine the current maternal and fetal selection criteria and operative approaches used at centers performing fetal myelomeningocele surgery. METHODS: The 17 principal investigators participating in the Fetal Myelomeningocele Consortium were asked to participate in an anonymous online survey regarding the current practice of maternal-fetal surgery for neural tube defect repair and results were tabulated. The 35-question survey related to diagnostic testing, inclusion and exclusion criteria, and clinical management. RESULTS: Sixty-five percent (11/17) of principal investigators responded to the survey and not all centers responded to all 35 questions. All centers continue to use magnetic resonance imaging in their preoperative evaluation. Diagnostic testing from amniocentesis is varied: 5 of 11 (45%) require amniotic fluid a-fetoprotein, 4 of 10 (40%) amniotic fluid acetylcholinesterase, and 8 of 11 (73%) DNA microarray. There is also variation from the Management of Myelomeningocele Study with regard to body mass index (BMI) (1/11; 9% would offer surgery with BMIs higher than 35), maternal medical risk factors (surgery would be offered for controlled pregestational diabetes [3/10 (30%)]), hepatitis C with negative viral load (4/11 [36%]), and human immunodeficiency virus with an undetectable viral load (1/10 [10%] or an obstetric history [3/11 (27%)] would offer surgery with a history of preterm delivery on progesterone). Ten of 11 (91%) centers did not consider ventriculomegaly of 18 mm and 9 of 11 (82%) centers did not consider lack of leg movement as an exclusion criteria. Nuances in the perioperative and intraoperative management were also reported, including 5 of 11 (45%) use intraoperative echocardiography and alterations in postoperative tocolytics. CONCLUSION: Variation in practice patterns for offering and performing maternal-fetal surgery for myelomeningocele repair exists among centers. Ongoing evaluation of inclusion and exclusion criteria as well as operative techniques is warranted to ensure continued safety, effectiveness, and beneficence.

Original languageEnglish (US)
Pages (from-to)593-597
Number of pages5
JournalObstetrics and Gynecology
Volume127
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

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Fetal Therapies
Meningomyelocele
Patient Selection
Mothers
Amniotic Fluid
Viral Load
Research Personnel
Tocolytic Agents
Fetal Proteins
Beneficence
Amniocentesis
Neural Tube Defects
Acetylcholinesterase
Hepatitis C
Oligonucleotide Array Sequence Analysis
Obstetrics
Progesterone
Echocardiography
Leg
Body Mass Index

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Moise, K. J., Moldenhauer, J. S., Bennett, K. A., Goodnight, W., Luks, F. I., Emery, S. P., ... Wetjen, N. M. (2016). Current Selection Criteria and Perioperative Therapy Used for Fetal Myelomeningocele Surgery. Obstetrics and Gynecology, 127(3), 593-597. https://doi.org/10.1097/AOG.0000000000001296

Current Selection Criteria and Perioperative Therapy Used for Fetal Myelomeningocele Surgery. / Moise, Kenneth J.; Moldenhauer, Julie S.; Bennett, Kelly A.; Goodnight, William; Luks, Francois I.; Emery, Stephen P.; Tsao, Kuojen; Moon, Anita J.; Moore, R. Clifton; Treadwell, Marjorie C.; Vlastos, Emanuel J.; Wetjen, Nicholas M.

In: Obstetrics and Gynecology, Vol. 127, No. 3, 01.03.2016, p. 593-597.

Research output: Contribution to journalArticle

Moise, KJ, Moldenhauer, JS, Bennett, KA, Goodnight, W, Luks, FI, Emery, SP, Tsao, K, Moon, AJ, Moore, RC, Treadwell, MC, Vlastos, EJ & Wetjen, NM 2016, 'Current Selection Criteria and Perioperative Therapy Used for Fetal Myelomeningocele Surgery', Obstetrics and Gynecology, vol. 127, no. 3, pp. 593-597. https://doi.org/10.1097/AOG.0000000000001296
Moise, Kenneth J. ; Moldenhauer, Julie S. ; Bennett, Kelly A. ; Goodnight, William ; Luks, Francois I. ; Emery, Stephen P. ; Tsao, Kuojen ; Moon, Anita J. ; Moore, R. Clifton ; Treadwell, Marjorie C. ; Vlastos, Emanuel J. ; Wetjen, Nicholas M. / Current Selection Criteria and Perioperative Therapy Used for Fetal Myelomeningocele Surgery. In: Obstetrics and Gynecology. 2016 ; Vol. 127, No. 3. pp. 593-597.
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abstract = "OBJECTIVE: To determine the current maternal and fetal selection criteria and operative approaches used at centers performing fetal myelomeningocele surgery. METHODS: The 17 principal investigators participating in the Fetal Myelomeningocele Consortium were asked to participate in an anonymous online survey regarding the current practice of maternal-fetal surgery for neural tube defect repair and results were tabulated. The 35-question survey related to diagnostic testing, inclusion and exclusion criteria, and clinical management. RESULTS: Sixty-five percent (11/17) of principal investigators responded to the survey and not all centers responded to all 35 questions. All centers continue to use magnetic resonance imaging in their preoperative evaluation. Diagnostic testing from amniocentesis is varied: 5 of 11 (45{\%}) require amniotic fluid a-fetoprotein, 4 of 10 (40{\%}) amniotic fluid acetylcholinesterase, and 8 of 11 (73{\%}) DNA microarray. There is also variation from the Management of Myelomeningocele Study with regard to body mass index (BMI) (1/11; 9{\%} would offer surgery with BMIs higher than 35), maternal medical risk factors (surgery would be offered for controlled pregestational diabetes [3/10 (30{\%})]), hepatitis C with negative viral load (4/11 [36{\%}]), and human immunodeficiency virus with an undetectable viral load (1/10 [10{\%}] or an obstetric history [3/11 (27{\%})] would offer surgery with a history of preterm delivery on progesterone). Ten of 11 (91{\%}) centers did not consider ventriculomegaly of 18 mm and 9 of 11 (82{\%}) centers did not consider lack of leg movement as an exclusion criteria. Nuances in the perioperative and intraoperative management were also reported, including 5 of 11 (45{\%}) use intraoperative echocardiography and alterations in postoperative tocolytics. CONCLUSION: Variation in practice patterns for offering and performing maternal-fetal surgery for myelomeningocele repair exists among centers. Ongoing evaluation of inclusion and exclusion criteria as well as operative techniques is warranted to ensure continued safety, effectiveness, and beneficence.",
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AU - Moldenhauer, Julie S.

AU - Bennett, Kelly A.

AU - Goodnight, William

AU - Luks, Francois I.

AU - Emery, Stephen P.

AU - Tsao, Kuojen

AU - Moon, Anita J.

AU - Moore, R. Clifton

AU - Treadwell, Marjorie C.

AU - Vlastos, Emanuel J.

AU - Wetjen, Nicholas M.

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N2 - OBJECTIVE: To determine the current maternal and fetal selection criteria and operative approaches used at centers performing fetal myelomeningocele surgery. METHODS: The 17 principal investigators participating in the Fetal Myelomeningocele Consortium were asked to participate in an anonymous online survey regarding the current practice of maternal-fetal surgery for neural tube defect repair and results were tabulated. The 35-question survey related to diagnostic testing, inclusion and exclusion criteria, and clinical management. RESULTS: Sixty-five percent (11/17) of principal investigators responded to the survey and not all centers responded to all 35 questions. All centers continue to use magnetic resonance imaging in their preoperative evaluation. Diagnostic testing from amniocentesis is varied: 5 of 11 (45%) require amniotic fluid a-fetoprotein, 4 of 10 (40%) amniotic fluid acetylcholinesterase, and 8 of 11 (73%) DNA microarray. There is also variation from the Management of Myelomeningocele Study with regard to body mass index (BMI) (1/11; 9% would offer surgery with BMIs higher than 35), maternal medical risk factors (surgery would be offered for controlled pregestational diabetes [3/10 (30%)]), hepatitis C with negative viral load (4/11 [36%]), and human immunodeficiency virus with an undetectable viral load (1/10 [10%] or an obstetric history [3/11 (27%)] would offer surgery with a history of preterm delivery on progesterone). Ten of 11 (91%) centers did not consider ventriculomegaly of 18 mm and 9 of 11 (82%) centers did not consider lack of leg movement as an exclusion criteria. Nuances in the perioperative and intraoperative management were also reported, including 5 of 11 (45%) use intraoperative echocardiography and alterations in postoperative tocolytics. CONCLUSION: Variation in practice patterns for offering and performing maternal-fetal surgery for myelomeningocele repair exists among centers. Ongoing evaluation of inclusion and exclusion criteria as well as operative techniques is warranted to ensure continued safety, effectiveness, and beneficence.

AB - OBJECTIVE: To determine the current maternal and fetal selection criteria and operative approaches used at centers performing fetal myelomeningocele surgery. METHODS: The 17 principal investigators participating in the Fetal Myelomeningocele Consortium were asked to participate in an anonymous online survey regarding the current practice of maternal-fetal surgery for neural tube defect repair and results were tabulated. The 35-question survey related to diagnostic testing, inclusion and exclusion criteria, and clinical management. RESULTS: Sixty-five percent (11/17) of principal investigators responded to the survey and not all centers responded to all 35 questions. All centers continue to use magnetic resonance imaging in their preoperative evaluation. Diagnostic testing from amniocentesis is varied: 5 of 11 (45%) require amniotic fluid a-fetoprotein, 4 of 10 (40%) amniotic fluid acetylcholinesterase, and 8 of 11 (73%) DNA microarray. There is also variation from the Management of Myelomeningocele Study with regard to body mass index (BMI) (1/11; 9% would offer surgery with BMIs higher than 35), maternal medical risk factors (surgery would be offered for controlled pregestational diabetes [3/10 (30%)]), hepatitis C with negative viral load (4/11 [36%]), and human immunodeficiency virus with an undetectable viral load (1/10 [10%] or an obstetric history [3/11 (27%)] would offer surgery with a history of preterm delivery on progesterone). Ten of 11 (91%) centers did not consider ventriculomegaly of 18 mm and 9 of 11 (82%) centers did not consider lack of leg movement as an exclusion criteria. Nuances in the perioperative and intraoperative management were also reported, including 5 of 11 (45%) use intraoperative echocardiography and alterations in postoperative tocolytics. CONCLUSION: Variation in practice patterns for offering and performing maternal-fetal surgery for myelomeningocele repair exists among centers. Ongoing evaluation of inclusion and exclusion criteria as well as operative techniques is warranted to ensure continued safety, effectiveness, and beneficence.

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