BACKGROUND
Open intrauterine fetal myelomeningocele repair has demonstrated decreased ventriculoperitoneal
shunting and improved motor outcomes despite maternal and fetal risks. Few data directly
compare the safety of open vs endoscopic approaches.
OBJECTIVE
This study aimed to analyze in-hospital maternal and fetal outcomes of pregnant patients
undergoing open vs endoscopic fetal myelomeningocele repair using a large, multi-center
database.
STUDY DESIGN
This was a review of the Pediatric Health Information System database from October
1, 2015, to December 31, 2021. All patients who underwent open or endoscopic fetal
myelomeningocele repair according to the International Classification of Diseases,
Tenth Revision, were identified. Demographics, gestational age, and outcomes were
analyzed. Descriptive and univariate statistics were used.
RESULTS
A total of 378 pregnant patients underwent fetal myelomeningocele repair. The approach
was endoscopic in 143 cases (37.8%) and open in 235 cases (62.2%). Overall postprocedural
outcomes included no maternal in-hospital mortalities or intensive care unit admissions,
a median length of stay of 4 days (interquartile range, 4–5), 14 cases (3.7%) of surgical
and postoperative complications, 6 cases (1.6%) of intrauterine infections, 12 cases
(3.2%) of obstetrical complications (including preterm premature rupture of membranes),
3 cases (0.8%) of intrauterine fetal demise, and 16 cases (4.2%) of preterm delivery.
Compared with an open approach, the endoscopic approach occurred at a later gestational
age (25 weeks [interquartile range, 24–25] vs 24 weeks [interquartile range, 24–25];
P<.001) and had an increased rate of intrauterine infection (6 [4.2%] cases vs 0 [0%]
case; P=.002). There was no difference between approaches in the rates of surgical complications,
obstetrical complications, intrauterine fetal demise, or preterm deliveries.
CONCLUSION
Compared with an open approach, endoscopic fetal myelomeningocele repair displays
a comparable rate of fetal complications, including intrauterine fetal demise and
preterm delivery, and a similar in-hospital maternal safety profile despite an association
with increased intrauterine infection.
Key words
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Article info
Publication history
Published online: December 29, 2022
Accepted:
December 26,
2022
Received:
November 28,
2022
Footnotes
The authors report no conflict of interest.
This study received no funding.
The abstract from this study was presented at the American College of Surgeons’ Clinical Congress 2022, San Diego, CA, October 18, 2022.
Cite this article as: Mikulski MF, Well A, Beckerman Z, et al. Open and endoscopic fetal myelomeningocele surgeries display similar in-hospital safety profiles in a large, multi-institutional database. Am J Obstet Gynecol MFM 2023;XX:x.ex–x.ex.
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