Outcomes after In Utero Myelomeningocele Repair Based on Delivery Location.

Eric P Bergh,Suzanne M Lopez,Anthony Johnson,Kuojen Tsao,Mary T Austin,Ramesha Papanna,Kenneth J Moise,Stephen A Fletcher

doi:10.3390/jcm9113443

Abstract

Maternal and pediatric delivery outcomes may vary in patients who underwent open fetal myelomeningocele repair and elected to deliver at the fetal center where their fetal intervention was performed versus at the referring physician’s hospital. A prospective cohort study of 88 patients were evaluated following in utero open fetal myelomeningocele repair at a single fetal center between the years 2011–2019. Exclusion criteria included patients that delivered within two weeks of the procedure (n = 6), or if a patient was lost to follow-up (n = 1). Of 82 patients meeting inclusion criteria, 36 (44%) patients were delivered at the fetal center that performed fetal intervention, and 46 (56%) were delivered locally. Comparative statistics found that with the exception of parity, baseline characteristics and pre-operative variables did not differ between the groups. No differences in oligohydramnios incidence, preterm rupture of membranes, gestational age at delivery or delivery indications were found. Patients who delivered with a referring physician were more likely to be multiparous (p = 0.015). With the exception of a longer neonatal intensive care unit (NICU) stay in the fetal center group (median 30.0 vs. 11.0 days, p = 0.004), there were no differences in neonatal outcomes, including wound dehiscence, cerebrospinal fluid leakage, patch management, ventricular diversion, or prematurity complications. Therefore, we conclude that it is safe to allow patients to travel home for obstetric and neonatal management after open fetal myelomeningocele repair.

Highlights

At many centers in the United States, patients who choose to undergo in utero surgery for open fetal myelomeningocele repair are required to relocate to the surgical center for the duration of their pregnancy
Any patient electing to proceed with surgery was asked to relocate to a residence within 30 min of the fetal center for the first two weeks post-discharge from the hospital, after which patients could return home to be managed by their referring physician
Six patients (6.8%) who delivered within two weeks of the procedure while under initial post-operative observation at the fetal center were excluded from analysis

Summary

Introduction

At many centers in the United States, patients who choose to undergo in utero surgery for open fetal myelomeningocele repair are required to relocate to the surgical center for the duration of their pregnancy. In keeping with recommendations by the Maternal–Fetal Management Task Force [2], our practice is to discharge stable patients home after two weeks of outpatient observation in order to continue prenatal care with their referring physician with an anticipated delivery at their local hospital. It is unknown whether the location of subsequent prenatal care and delivery have an influence on maternal and perinatal outcomes. We compared obstetric and neonatal outcomes in a population of patients who underwent open fetal myelomeningocele repair and were either delivered at the fetal center where fetal intervention was performed or at their referring physicians’ hospital

Methods

Results

Discussion

Conclusion