Fetal Myelomeningocele: Antenatal Characteristics and Pregnancy Outcomes [19R

Abstract

INTRODUCTION: Spina bifida is the most common fetal anomaly of the central nervous system, which affect 1:1000 live births in the United States. Myelomeningocele is the most common presentation of spina bifida, representing half of these cases. Given the meningeal membrane sac may contain spinal cord, cerebrospinal fluid and nerve roots, this defect results in significant morbidity to infants and major life-long disabilities. In this study we aimed to identify maternal and fetal characteristics associated with expectant management or termination of pregnancy in the setting of antenatally diagnosed Myelomeningocele. METHODS: A retrospective cohort analysis was performed with patients who had presented to the Cleveland Clinic Fetal Care Center between 2005-2017. Live births then followed up at the pediatric Myelomeningocele clinic within our institution. RESULTS: Our data showed 40% of patients with antenatally diagnosed Myelomeningocele elected for second trimester terminations vs. 60% who chose to continue either by cesarean section or vaginal delivery. Based off ultrasound findings, there were no significant differences among these two groups. Maternal body mass index was significantly higher in those who continued pregnancies (p<0.05). In addition, the fetal diagnostic methods chosen by patients was significantly different. Those who elected to terminate were more likely to pursue amniocentesis instead of MRI characterization of the fetus (p<0.02). CONCLUSION: Taken together, we conclude, in the setting of antenatally diagnosed Myelomeningocele, patients often rely less on the associated ultrasonographic findings and depend more on maternal characteristics as well as fetal diagnostics in determining whether to continue or terminate pregnancy in the second trimester.