Two-port, exteriorized uterus, fetoscopic meningomyelocele closure has fewer adverse neonatal outcomes than open hysterotomy closure.

Abstract

BACKGROUND:

In utero closure of meningomyelocele using an open hysterotomy approach is associated with preterm delivery and adverse neonatal outcomes.

OBJECTIVE:

This study compared the neonatal outcomes in in utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach vs the conventional open hysterotomy approach.

STUDY DESIGN:

This retrospective cohort study included all consecutive patients who underwent in utero meningomyelocele closure using open hysterotomy (n=44) or a 2-port, exteriorized uterus, fetoscopic approach (n=46) at a single institution between 2012 and 2020. The 2-port, exteriorized uterus, fetoscopic closure was composed of the following 3 layers: a bovine collagen patch, a myofascial layer, and a skin. The frequency of respiratory distress syndrome and a composite of other adverse neonatal outcomes, including retinopathy of prematurity, periventricular leukomalacia, and perinatal death, were compared between the study groups. Regression analyses were performed to determine any association between the fetoscopic closure and adverse neonatal outcomes, adjusted for several confounders, including gestational age of <37 weeks at delivery.

RESULTS:

The fetoscopic closure was associated with a lower rate of respiratory distress syndrome than the open hysterotomy closure (11.5% [5 of 45] vs 29.5% [13 of 44]; P=.037). The proportion of neonates with a composite of other adverse neonatal outcomes in the fetoscopic group was half of that observed patients in the open hysterotomy group; however, this difference did not reach statistical significance (4.3% [2 of 46] vs 9.1% [4 of 44]; P=.429). Here, regression analysis has demonstrated that fetoscopic meningomyelocele closure was associated with a lower risk of respiratory distress syndrome (adjusted odds ratio, 0.23; 95% confidence interval, 0.06-0.84; P=.026) than open hysterotomy closure.

CONCLUSION:

In utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach was associated with a lower risk of respiratory distress syndrome than the conventional open hysterotomy meningomyelocele closure.

• Authors: Jimmy Espinoza, Alireza A Shamshirsaz, Magdalena Sanz Cortes, Mohan Pammi, Ahmed A Nassr, Roopali Donepudi, William E Whitehead, Jonathan Castillo, Rebecca Johnson, Nazli Meshinchi, Raphael Sun, Eyal Krispin, Romain Corroenne, Timothy C Lee, Sundeep G Keswani, Alice King, Michael A Belfort
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 225 Issue 3 Pg. 327.e1-327.e9 (09 2021) ISSN: 1097-6868 [Electronic] United States
• PMID: 33957114 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Topics

• Adult
• Cohort Studies
• Female
• Fetoscopy (methods)
• Humans
• Hysterotomy (methods)
• Infant, Newborn
• Meningomyelocele (surgery)
• Middle Aged
• Pregnancy
• Respiratory Distress Syndrome, Newborn (epidemiology)
• Retrospective Studies
• Young Adult