388 Evaluation of risk of preterm birth and obstetrical outcome stratified by fetal intervention

Abstract

To evaluate the risk of preterm delivery and prelabor rupture of membranes (PPROM) following ultrasound guided, fetoscopic and open fetal intervention techniques. This is a retrospective cohort study of patients who underwent fetal intervention at our institution between October 1st 2016 and December 31st 2019. Interventions were stratified into three groups- ultrasound guided, fetoscopic and open procedures. Procedures include fetoscopic laser ablation for twin to twin transfusion syndrome, fetoscopic endotracheal occlusion for congenital diaphragmatic hernia, vesicoamniotic shunt for lower urinary tract obstruction, fetal cystoscopy for lower urinary tract obstruction, management of congenital pulmonary airway malformation, and open and fetoscopic myelomeningocele repair. Primary outcome was preterm birth classified as extreme (<28 0/7 weeks), moderate (28 0/7 to 31 6/7 weeks) and late preterm (32 0/7 to 36 6/7 weeks) delivery. Amongst 68 patients included; 20 (29.4%) underwent ultrasound guided, 37 (54.4%) fetoscopic, and 11 (16.2%) underwent open procedures. There was no significant difference in maternal age, race, gravida or parity in the groups. The diagnoses and type of intervention within each group were different. Mean gestational age (GA) ± SD at intervention for ultrasound guided, fetoscopic and open procedures were 24 1/7 weeks ± 4 days , 22 5/7 weeks ± 4 days, and 25 0/7 weeks ± 1 day respectively (p<0.01). The mean GA ± SD at delivery were 31 6/7 weeks ± 5 days, 31 4/7 weeks ± 5 days, and 32 4/7 weeks ± 5 days respectively (p= 0.87). The mean interval from time of intervention to delivery were 54 ± 39 days, 62 ± 37, and 55 ± 36 respectively (p= 0.82); and the risk of PPROM were 26.3%, 21.6%, and 27.3% respectively (p=0.89). Our study shows that ultrasound guided, fetoscopic, and open fetal interventions carry a similar risk of preterm labor and PPROM with a trend towards earlier delivery in the ultrasound guided group; secondary to PPROM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)