VP51.02: Outcomes of fetal microneurosurgery for intrauterine spina bifida repair in a country with a deficient health system

Abstract

We describe our initial experience with fetal microneurosurgery and its effect on improving fetal survival, gestational age at delivery and reducing complications from surgery in a country with a suboptimal health system. We selected a consecutive fetuses with confirmed spina bifida. Between November 2019 and November 2020, 12 singleton fetuses with confirmed lumbosacral open spina bifida, nine were selected for open fetal microneurosurgery as previously described by Dr. Rogelio Cruz Martinez group. The inclusion and exclusion criteria that are common for this surgery and already described by other authors were respected. The median gestational age at the moment to the surgery was 24.5 (range, 22.4–28) weeks. In all consecutive cases, fetal myeloplasty with a complete 3-layer correction was successfully performed. There were not any cases requiring conversion from microneurosurgery to the classic larger uterine incision. Nobody showed oligohydramnios, and PPROM 35 weeks GA showed in one case (11%), GA at birth greater than 36 weeks were 89 %. Admission to neonatal ICU due to neonatal prematurity in one case 11 % Interval between fetal intervention and delivery was 9.5 and 14.2 weeks. One patient (11 %) presented a raquisquisis larger than 3 * 3.5 cm, and the biological patch (Lyoplant Onlay) was used, whit a successful outcome. Nobody presented preterm delivery below 35 weeks and no presented perinatal death. All patients showed an intact hysterotomy site at delivery and there were no ultrasound signs of wound dehiscence. The average of the first obstetric surgical stage 25 min, neurosurgical time 57 min, second obstetric surgical stage 21 min. This new microhysterotomy technique appears to improve perinatal outcome. Especially in countries where the health system offers poor care. Our results check that this modified uterine surgical by Dr. Cruz group, approach achieves significant improvement in rates of preterm delivery and achieve improvements in gestational age at delivery.