Aim:
Fetal myelomeningocele (fMMC) repair is a therapeutic option in selected cases. The
total duration of fetal surgery and the occurrence of oligohydramnios before PPROM
are reported risk factors for preterm delivery. This study aimed at the identification
of risk factors for preterm birth following open fMMC repair.
Materials and methods:
Sixty-seven women underwent fMMC repair between 2010 and 2017 at our center. Demographic,
surgical, and pregnancy complications, including potential risk factors for preterm
birth (GA < 37 weeks) such as preterm premature rupture of membranes (PPROM), chorioamniotic
membrane separation (CMS) and placental abruption were evaluated using Chi Square
test and t-test.
Results:
Maternal Body Mass Index, maternal age, parity, previous uterine surgery, GA at intrauterine
surgery, total surgery time, surgical subcutaneous hematoma, oligohydramnios and amniotic
fluid leakage were not identified as risk factors for preterm birth. However, complications
directly attributed to the surgical interventions as CMS (p = 0.028, 92% vs. 52%)
and PPROM (p = 0.001, 95% vs. 52%) were highly associated with preterm birth. Placental
abruption was found more often after fMMC repair compared to a general obstetrical
population (12% versus 1%) and ended in premature birth in all cases (p = 0.024, 100%
vs. 60%). However the majority of women delivered at a gestational age > 35 weeks.
Conclusions:
In our study cohort, risk factors for preterm birth were PPROM, CMS and placental
abruption, whereas surgery time did not influence our outcome. We conclude that the
surgery technique should aim at minimizing CMS and amniotic fluid leakage.
