Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele

fMMC Consortium sponsored by NAFTNet

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)494.e1-494.e7
JournalAmerican journal of obstetrics and gynecology
Volume220
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Meningomyelocele
Pregnancy Outcome
Mothers
Pregnancy
Uterine Rupture
Registries
Gestational Age
Obstetrics
Morbidity
Spinal Dysraphism
Fetal Death
Birth Rate
Research Ethics Committees
Live Birth
Counseling

Keywords

  • cesarean delivery
  • fetal myelomeningocele
  • fetal myelomeningocele repair
  • fetal surgery
  • fMMC
  • myelomeningocele
  • open maternal fetal surgery
  • spina bifida
  • uterine rupture

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele. / fMMC Consortium sponsored by NAFTNet.

In: American journal of obstetrics and gynecology, Vol. 220, No. 5, 01.05.2019, p. 494.e1-494.e7.

Research output: Contribution to journalArticle

fMMC Consortium sponsored by NAFTNet. / Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele. In: American journal of obstetrics and gynecology. 2019 ; Vol. 220, No. 5. pp. 494.e1-494.e7.
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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.",
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AU - fMMC Consortium sponsored by NAFTNet

AU - Goodnight, William H.

AU - Bahtiyar, Ozan

AU - Bennett, Kelly A.

AU - Emery, Stephen P.

AU - Lillegard, J. B.

AU - Fisher, Allan

AU - Goldstein, Ruth

AU - Jatres, Jillian

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AU - Moehrlen, Ueli

AU - Moldenhauer, Julie S.

AU - Moon-Grady, Anita J.

AU - Ruano, Rodrigo

AU - Skupski, Daniel W.

AU - Thom, Elizabeth

AU - Treadwell, Marjorie C.

AU - Tsao, Kuo Jen

AU - Wagner, Amy J.

AU - Waqar, Lindsay N.

AU - Zaretsky, Michael

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N2 - 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.

AB - 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.

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KW - spina bifida

KW - uterine rupture

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