Preterm rupture of membranes following alternative hysterotomy for spina bifida open fetal surgery: systematic review

Abstract

The objective of this study was to establish whether different types of hysterotomy technique for spina bifida open fetal surgery impact in preterm prelabor rupture of membranes (PPROM) rates. Before data extraction, the project was registered in the PROSPERO International Register of Systematic Reviews (registration number: CRD42021249622). A systematic search was performed to identify relevant studies, using PubMed, Embase, Web of Science and Cochrane Library databases. Alternative hysterotomy technique was defined as opening with sutures and size ≥ 4cm (as opposed to mini-hysterotomy or fetal microneurosurgery). The comparison was made with studies reporting standard technique (with staplers and size from 6-8 cm) published post-MOMs trial (after 2011). The incidence of the main outcome (PPROM before 37 weeks’ gestation) and other relevant variables were compared using Mann-Whitney test, with significance level as a two-sided p-value < 0.05. From 3636 assessed studies, 217 were selected by title and abstract. Fifty-nine were excluded due to duplicated records. One hundred fifty-eight full-text articles were reviewed and 27 were selected as relevant. From those, 14 were excluded due to duplication of data and one due to lack of data in the main outcome. Therefore, 12 studies were retained for analysis, 2 of them addressing alternative hysterotomy and 10 reporting standard technique follow up. The results showed no differences in maternal characteristics such as age, BMI or gestational age at surgery. Median PPROM rates were not significantly different between groups [27.9% (standard) vs. 20.8% (alternative)], p=0.39. Other perinatal parameters such as placental abruption, chorioamniotic separation, fetal death, preterm delivery, gestational age at birth, and birth weight were not significantly different. Women undergoing open fetal surgery for spina bifida with alternative hysterotomy technique had similar PPROM rates as those undergoing standard technique.