Length of hysterotomy for fetal spina bifida repair is associated with prematurity risk.

Abstract

To investigate whether prenatal repair of spina bifida aperta through mini-hysterotomy results in less prematurity, as compared to standard hysterotomy, when adjusting for known prematurity risks. We performed a bi-centric, propensity score matched, controlled study, that is, adjusting for factors earlier reported to result in premature delivery or membrane rupture, in consecutive women having prenatal repair either through stapled hysterotomy or sutured mini-hysterotomy (≤3.5cm). Matches were pairwise compared and cox-regression analysis was performed to define the hazard ratio of delivery <37weeks. Of 346 meeting the MOMS-criteria, 78 comparable pairs were available for matched-controlled analysis. Mini-hysterotomy patients were younger and had a higher BMI. Mini-hysterotomy was associated with a 1.67-lower risk of delivery <37weeks (hazard ratio: 0.60; 95% CI: 0.42-0.85; p=0.004) and 1.72 for delivery <34+6weeks (hazard ratio: 0.58; 95% CI: 0.34-0.97; p=0.037). The rate of intact uterine scar at birth (mini-hysterotomy: 98.7% vs. hysterotomy: 90.4%; p=0.070), the rate of reversal of hindbrain herniation within 1week after surgery (88.9% vs. 97.4%; p=0.180) and the rate of cerebrospinal fluid leakage (0% vs. 2.7%; p=0.50) were comparable. Prenatal spina bidifa repair through mini-hysterotomy was associated with a later gestational age at delivery and a comparable intact uterus rate without apparent compromise in neuroprotection.