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Am J Obstet Gynecol. 2003 Aug;189(2):482-7.

Fetal myelomeningocele repair: short-term clinical outcomes.

Author information

  • 1Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadephia, PA 19104, USA. johnsonma@email.chop.edu

Abstract

OBJECTIVE:

The study was undertaken to evaluate short-term clinical outcomes with antenatal myelomeningocele (MMC) repair.

STUDY DESIGN:

Retrospective review of 50 fetuses that underwent open fetal MMC closure was performed. Inclusion criteria included less than 26 weeks' gestation, thoracic to S1 level defect, absent clubfoot deformity, Arnold-Chiari malformation, ventriculomegaly less than 17 mm, normal karyotype, and no other anomalies.

RESULTS:

Perinatal survival was 94% (47/50 fetuses). Mean age at delivery was 34 weeks 3 days. All fetuses demonstrated reversal of hindbrain herniation. Forty-three percent of the 50 fetuses have required ventriculoperitoneal shunting compared with 100% thoracic, 88% lumbar, and 68% sacral (85% overall) in 297 historic controls. Better-than-predicted leg function was seen in 57% of thoracic and lumbar level lesion patients.

CONCLUSION:

Early experience with fetal MMC repair suggests a decreased need for ventriculoperitoneal shunting, arrest or slowing of progressive ventriculomegaly, and consistent resolution of hindbrain herniation. However, further long-term follow-up is needed to evaluate neurodevelopment and bladder and bowel function.

PMID:
14520222
[PubMed - indexed for MEDLINE]
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