Outcomes after In Utero Myelomeningocele Repair Based on Delivery Location
Maternal and pediatric delivery outcomes may vary in patients who underwent open fetal myelomeningocele repair and elected to deliver at the fetal center where their fetal intervention was performed versus at the referring physician’s hospital. A prospective cohort study of 88 patients were evaluate...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/11/3443 |
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| author | Eric P. Bergh Kuojen Tsao Mary T. Austin Stephen A. Fletcher Suzanne M. Lopez Kenneth J. Moise Anthony Johnson Ramesha Papanna |
| author_facet | Eric P. Bergh Kuojen Tsao Mary T. Austin Stephen A. Fletcher Suzanne M. Lopez Kenneth J. Moise Anthony Johnson Ramesha Papanna |
| author_sort | Eric P. Bergh |
| collection | DOAJ |
| description | Maternal and pediatric delivery outcomes may vary in patients who underwent open fetal myelomeningocele repair and elected to deliver at the fetal center where their fetal intervention was performed versus at the referring physician’s hospital. A prospective cohort study of 88 patients were evaluated following in utero open fetal myelomeningocele repair at a single fetal center between the years 2011–2019. Exclusion criteria included patients that delivered within two weeks of the procedure (<i>n</i> = 6), or if a patient was lost to follow-up (<i>n</i> = 1). Of 82 patients meeting inclusion criteria, 36 (44%) patients were delivered at the fetal center that performed fetal intervention, and 46 (56%) were delivered locally. Comparative statistics found that with the exception of parity, baseline characteristics and pre-operative variables did not differ between the groups. No differences in oligohydramnios incidence, preterm rupture of membranes, gestational age at delivery or delivery indications were found. Patients who delivered with a referring physician were more likely to be multiparous (<i>p</i> = 0.015). With the exception of a longer neonatal intensive care unit (NICU) stay in the fetal center group (median 30.0 vs. 11.0 days, <i>p</i> = 0.004), there were no differences in neonatal outcomes, including wound dehiscence, cerebrospinal fluid leakage, patch management, ventricular diversion, or prematurity complications. Therefore, we conclude that it is safe to allow patients to travel home for obstetric and neonatal management after open fetal myelomeningocele repair. |
| first_indexed | 2024-03-10T15:19:26Z |
| format | Article |
| id | doaj.art-1bdfa95862d6469ba72f457ead0c9396 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T15:19:26Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1bdfa95862d6469ba72f457ead0c93962023-11-20T18:38:11ZengMDPI AGJournal of Clinical Medicine2077-03832020-10-01911344310.3390/jcm9113443Outcomes after In Utero Myelomeningocele Repair Based on Delivery LocationEric P. Bergh0Kuojen Tsao1Mary T. Austin2Stephen A. Fletcher3Suzanne M. Lopez4Kenneth J. Moise5Anthony Johnson6Ramesha Papanna7Departments Obstetrics, Gynecology & Reproductive Sciences and Pediatric Surgery, Division of Maternal-Fetal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX 77030, USADepartments of Pediatric Surgery and Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX 77030, USADepartments of Pediatric Surgery and Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX 77030, USADivision of Pediatric Neurosurgery, Department of Pediatrics, and Department of Pediatric Surgery, UTHealth the University of Texas McGovern Medical School, Houston, TX 77030, USADepartment of Pediatrics, McGovern Medical School—UTHealth, Houston, TX 77030, USADepartment of Women’s Health, The University of Texas at Austin, Dell Medical Shool, Austin, TX 77030, USADepartments Obstetrics, Gynecology & Reproductive Sciences and Pediatric Surgery, Division of Maternal-Fetal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX 77030, USADepartments Obstetrics, Gynecology & Reproductive Sciences and Pediatric Surgery, Division of Maternal-Fetal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX 77030, USAMaternal and pediatric delivery outcomes may vary in patients who underwent open fetal myelomeningocele repair and elected to deliver at the fetal center where their fetal intervention was performed versus at the referring physician’s hospital. A prospective cohort study of 88 patients were evaluated following in utero open fetal myelomeningocele repair at a single fetal center between the years 2011–2019. Exclusion criteria included patients that delivered within two weeks of the procedure (<i>n</i> = 6), or if a patient was lost to follow-up (<i>n</i> = 1). Of 82 patients meeting inclusion criteria, 36 (44%) patients were delivered at the fetal center that performed fetal intervention, and 46 (56%) were delivered locally. Comparative statistics found that with the exception of parity, baseline characteristics and pre-operative variables did not differ between the groups. No differences in oligohydramnios incidence, preterm rupture of membranes, gestational age at delivery or delivery indications were found. Patients who delivered with a referring physician were more likely to be multiparous (<i>p</i> = 0.015). With the exception of a longer neonatal intensive care unit (NICU) stay in the fetal center group (median 30.0 vs. 11.0 days, <i>p</i> = 0.004), there were no differences in neonatal outcomes, including wound dehiscence, cerebrospinal fluid leakage, patch management, ventricular diversion, or prematurity complications. Therefore, we conclude that it is safe to allow patients to travel home for obstetric and neonatal management after open fetal myelomeningocele repair.https://www.mdpi.com/2077-0383/9/11/3443in utero open fetal myelomeningocele repairobstetric and neonatal managementdelivery locationneonatal outcomesmaternal outcomesreferring physician |
| spellingShingle | Eric P. Bergh Kuojen Tsao Mary T. Austin Stephen A. Fletcher Suzanne M. Lopez Kenneth J. Moise Anthony Johnson Ramesha Papanna Outcomes after In Utero Myelomeningocele Repair Based on Delivery Location Journal of Clinical Medicine in utero open fetal myelomeningocele repair obstetric and neonatal management delivery location neonatal outcomes maternal outcomes referring physician |
| title | Outcomes after In Utero Myelomeningocele Repair Based on Delivery Location |
| title_full | Outcomes after In Utero Myelomeningocele Repair Based on Delivery Location |
| title_fullStr | Outcomes after In Utero Myelomeningocele Repair Based on Delivery Location |
| title_full_unstemmed | Outcomes after In Utero Myelomeningocele Repair Based on Delivery Location |
| title_short | Outcomes after In Utero Myelomeningocele Repair Based on Delivery Location |
| title_sort | outcomes after in utero myelomeningocele repair based on delivery location |
| topic | in utero open fetal myelomeningocele repair obstetric and neonatal management delivery location neonatal outcomes maternal outcomes referring physician |
| url | https://www.mdpi.com/2077-0383/9/11/3443 |
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