Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta-analysis.

Adalina Sacco,Jan Deprest,Anna L David,Lennart Van Der Veeken,Catherine Ferguson,Tim Van Mieghem,Emma Bagshaw

doi:10.1002/pd.5421

Adalina Sacco, Jan Deprest + Show 5 more

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https://doi.org/10.1002/pd.5421

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Abstract

ObjectiveTo establish maternal complication rates for fetoscopic or open fetal surgery.MethodsWe conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery, and after the index pregnancy.ResultsOne hundred sixty‐six studies were included, reporting outcomes for open fetal (n = 1193 patients) and fetoscopic surgery (n = 9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI, 15.22‐27.13) for open fetal and 6.2% (95%CI, 4.93‐7.49) for fetoscopic surgery. For severe maternal complications (grades III to V Clavien‐Dindo classification of surgical complications), the risk was 4.5% (95% CI 3.24‐5.98) for open fetal and 1.7% (95% CI, 1.19‐2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n = 175, 23.3%) was excluded for failing to report the presence or absence of maternal complications.ConclusionsMaternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures.Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies.

Highlights

The last 35 years have witnessed an expansion of fetal therapy options,1,2 with surgery on the fetus, placenta, or cord relatively common in tertiary‐level fetal medicine units
In this systematic review of the literature, we found an overall complication rate of approximately 21% for open fetal surgery and 6% for fetoscopic fetal surgery, of which minor complications occurred in 16% and 4% of surgeries, respectively
We found that maternal complications were often presented from the fetal perspective

Summary

Introduction

The last 35 years have witnessed an expansion of fetal therapy options, with surgery on the fetus, placenta, or cord relatively common in tertiary‐level fetal medicine units. The mother has been called an “innocent bystander” in fetal surgery, and generally, fetal therapy is almost exclusively offered to women who are healthy themselves. Fetal surgery poses risks to the mother during the procedure itself and throughout the Prenatal Diagnosis. Fetal surgery offers no direct medical benefit to the mother, and from an ethical perspective, maternal risks should be minor and acceptable to the mother and family.. One single‐centre study of maternal outcomes following both open fetal and fetoscopic surgery performed between 1989 and 2003 found a number of short‐term morbidities.. The aim of this study was to estimate the incidence of immediate and long‐term maternal complications of fetoscopic or open fetal surgery through a systematic review of the literature

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