Abstract
To assess factors precluding open fetal surgery in pregnancies with prenatal diagnosis of open spina bifida (OSB). From October 2015 to January 2021, a prospective cohort of pregnancies with prenatal diagnosis of OSB selected for intrauterine OSB repair in our national referral fetal surgery centre at Queretaro, Mexico was constructed. All exclusion criteria for fetal surgery were analysed. During the study period, 236 OSB cases were evaluated, 75 (31.7%) underwent open fetal surgery and 161 fetuses were excluded. Within the population excluded for fetal surgery, 39.75% (64/161) were diagnosed or referred beyond 28 weeks of gestation, 35.40% (57/161) showed additional structural or chromosomal abnormalities, 13.66% (22/161) refused fetal intervention, 4.99% (8/161) did not show Chiari II Malformation, 1.24% (2/161) showed maternal medical contraindications for surgery, 1.24% (2/161) procedures were abandoned before performing maternal laparotomy due to anaphylactic shock, 1.24% (2/161) showed short cervical length (< 25mm), 1.24% (2/161) were twin pregnancies, and 1.24% (2/161) the diagnosis was not confirmed. In pregnancies complicated with OSB late prenatal diagnosis is the main factor precluding fetal surgery. This finding highlights the need to improve strategies to enhance access to advanced fetal evaluations in Mexico which will allow an accurate diagnosis and early referral to fetal surgery centres.
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