Z Geburtshilfe Neonatol 2019; 223(S 01): E34
DOI: 10.1055/s-0039-3401146
Vorträge
Georg Thieme Verlag KG Stuttgart · New York

Open Fetal Spina Bifida Repair at the Zurich Center for Fetal Diagnosis and Therapy: Outcome of the first 100 cases

U Möhrlen
1   Universitäts- Kinderspital Zürich, Fetale Diagnostik und Therapie, Zürich, Schweiz
,
N Ochsenbein
2   Universitätsspital Zürich, Klinik für Geburtshilfe, Zürich, Schweiz
,
F Krähenmann
2   Universitätsspital Zürich, Klinik für Geburtshilfe, Zürich, Schweiz
,
R Kottke
3   Universitäts- Kinderspital Zürich, Abteilung für Bilddiagnostik, Zürich, Schweiz
,
L Mazzone
1   Universitäts- Kinderspital Zürich, Fetale Diagnostik und Therapie, Zürich, Schweiz
,
S Schauer
4   Universitäts- Kinderspital Zürich, Abteilung für Neurochirurgie, Zürich, Schweiz
,
D Wille
5   Universitäts- Kinderspital Zürich, Abteilung für Neurologie, Zürich, Schweiz
,
R Zimmermann
2   Universitätsspital Zürich, Klinik für Geburtshilfe, Zürich, Schweiz
,
M Meuli
1   Universitäts- Kinderspital Zürich, Fetale Diagnostik und Therapie, Zürich, Schweiz
› Author Affiliations
Further Information

Publication History

Publication Date:
27 November 2019 (online)

Also available at
 

Background:

During the last 9 years, open fetal surgery became the standard therapy for select fetuses with spina bifida aperta (myelomeningocele (MMC), and myeloschisis (MS)) at the Zurich Center for Fetal Diagnosis and Therapy. We report here on the key outcome results of our first 100 patients.

Patients and Methods:

All patients were evaluated prenatally following a standardized protocol. Eligibility criteria were similar, but less strict than for the MOMS Trial. Operative procedures and pre- and postoperative management were basically identical to the ones at the Children“s Hospital of Philadelphia. All data were collected prospectively.

Results:

The first 100 women undergoing maternal-fetal surgery and, correspondingly, the first 100 babies born were enrolled in this analysis. Cesarian section was performed between 31+2 and 37+3 weeks of gestation (median 36+2 weeks). Maternal safety was warranted at all times in all women (100%), i.e. there were no maternal deaths or complications with persistent handicaps. Major complications were rare (1 – 3%), minor complications relatively frequent (10 – 30%). One fetus (1%) had to be delivered at the end of fetal surgery due to placental abruption (25+2 weeks). One baby (1%) died postnatally due to lung hypoplasia and intractable respiratory failure. As of today, the average ventriculoperitoneal shunt/endoscopic third ventriculostomy rate is 32%. 40 patients (40%) have a normal bladder and bowel function. Lower extremity function was better than predicted in 57 babies (57%). 3/68 mothers (4%) had a following pregnancy without complications. No unfulfilled wish for children is reported so far.

Conclusion:

Our results are very similar, or even better, compared to the MOMS- trial and data from the post MOMS era. Therefore, we conclude that select fetuses with MMC or MS benefit substantially from prenatal surgical repair. Mothers carrying a fetus with spina bifida must be counselled timely, competently, and non-directively concerning fetal surgery being an eventual therapeutic option.