817: Perinatal outcomes after fetal resuscitation during fetal MMC closure

Abstract

Fetal complications including extreme prematurity are known risks of fetal myelomeningocele (fMMC) closure. The objective of this study was to evaluate the rate of fetal resuscitation during fMMC closure, including incidence of delivery and evaluation of neonatal outcomes in these cases. An international multicenter registry was created to track and report maternal, obstetric, and fetal/neonatal outcomes for cases of open maternal-fetal surgery for MMC closure. Data are collected from each center and entered into a combined de-identified dataset using REDCap. Fetal resuscitation was defined as need for chest compression, fetal medication or transfusion. Intraoperative and neonatal outcomes in cases requiring fetal resuscitation were analyzed using descriptive statistics. Centers participating in the registry have obtained local IRB approval and executed data use agreements. A total of 750 cases of fMMC closure have been entered into the registry. Of those, fetal resuscitation was required in 14 cases (1.9%). Of the 14 resuscitation cases, 12received fetal medications, 8 received chest compressions, and 4 received fetal transfusion. For these 14 cases, median gestational age at the time of fetal surgery was 24.4 weeks (range 22.6-25.9) and median gestational age at delivery was 31.8 weeks (range 23.7-37.3). Of these, 4 were delivered on the day of maternal-fetal surgery and 1 was delivered within 1 week of maternal-fetal surgery. Four out of 14 resulted in perinatal death (29%). All 4 of these were delivered within 1 week of maternal-fetal surgery. Only 1 out of 5 that required delivery survived. Need for fetal resuscitation during fMMC closureis uncommon, with the need for immediate delivery being a rare event. Survival is poor when delivery is required. This data is useful for counseling patients prior to the procedure and can be helpful with complex decisions regarding neonatal resuscitation efforts.