Reducing complications for in utero fetal myelomeningocele closure
Management of Myelomeningocele Study (MOMS) reports that in utero myelomeningocele closure is associated with lower ventricular shunting rates and higher ambulation rate, but with a higher rate of chorioamnion separation, premature rupture of membranes, and preterm delivery compared to conventional closure. To reduce these pregnancy complications, Bennett et al describe a prospective cohort study comparing the MOMS prenatal cohort with a study cohort of 43 consecutive patients undergoing fetal myelomeningocele closure at one institution using a new surgical technique for uterine entry and closure, designed to minimize separation of the amniotic membrane. Statistically significant decrease in premature membrane rupture from 46% to 22%, decrease in chorioamnion separation from 26% to 0, and increase in infants born at 37 weeks or later (21% to 39%) were observed. This study shows potential for technical improvements to decrease fetal surgery complications and realize the benefits of in utero myelomeningocele closure.