Fetal open spinal dysraphism repair through a mini-hysterotomy: Influence of gestational age at surgery on the perinatal outcomes and postnatal shunt rates.

Autor: Peralta CFA; Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil.; Fetal Medicine Unit, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil.; Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil.; Fetal Medicine Unit, CETRUS - São Paulo Ultrasound Training Center, São Paulo, Brazil., Botelho RD; Fetal Medicine Unit, HCor Hospital do Coração, São Paulo, Brazil.; Fetal Medicine Unit, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil.; Fetal Medicine and Surgery Center (Gestar), São Paulo, Brazil., Romano ER; Intensive Care Unit, HCor Hospital do Coração, São Paulo, Brazil., Imada V; Department of Neuroscience, HCor Hospital do Coração, São Paulo, Brazil.; Department of Neurosurgery, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil., Lamis F; Department of Neuroscience, HCor Hospital do Coração, São Paulo, Brazil.; Department of Neurosurgery, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil., Júnior RR; Department of Anesthesiology, HCor Hospital do Coração, São Paulo, Brazil., Nani F; Department of Anesthesiology, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil., Stoeber GH; Intensive Care Unit, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil., de Salles AAF; Department of Neuroscience, HCor Hospital do Coração, São Paulo, Brazil.; Department of Neurosurgery, Pro Matre Paulista (Maternity Hospital - Grupo Santa Joana), São Paulo, Brazil.; Department of Neurosurgery, University of California, Los Angeles, California, USA.
Jazyk: angličtina
Zdroj: Prenatal diagnosis [Prenat Diagn] 2020 May; Vol. 40 (6), pp. 689-697. Date of Electronic Publication: 2020 Mar 09.
DOI: 10.1002/pd.5675
Abstrakt: Objective: To analyze the impact of gestational age (GA) at the time of fetal open spinal dysraphism (OSD) repair through a mini-hysterotomy on the perinatal outcomes and the infants' ventriculoperitoneal shunt rates.
Methods: Retrospective study of cases of fetal OSD correction performed from 2014 and 2019.
Results: One hundred and ninety women underwent fetal surgery for OSD through a mini-hysterotomy, and 176 (176/190:92.6%) have since delivered. Fetal OSD correction performed earlier in the gestational period, ranging from 19.7 to 26.9 weeks, was associated with lower rates of postnatal ventriculoperitoneal shunting (P: .049). Earlier fetal surgeries were associated with shorter surgical times (P: .01), smaller hysterotomy lengths (P < .001), higher frequencies of hindbrain herniation reversal (P: .003), and longer latencies from surgery to delivery (P < .001). Median GA at delivery was 35.3 weeks. Multivariate binary logistic regression showed that both fetal lateral ventricle-to-hemisphere ratio (%; P < .001; OR: 1.14 [95% CI: 1.09-1.21]) and GA at the time of fetal surgery (P: .016; OR: 1.37 [95% CI: 1.07-1.77]) were independent predictors of postnatal ventriculoperitoneal shunting.
Conclusion: Fetuses with OSD who were operated on earlier in the gestational interval, which ranged from 19.7 to 26.9 weeks, were less prone to receiving postnatal ventriculoperitoneal shunts.
(© 2020 John Wiley & Sons, Ltd.)
Databáze: MEDLINE
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