Length of hysterotomy for fetal spina bifida repair is associated with prematurity risk.

Autor: Watananirun K; My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Women and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.; Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand., Vargas AMLF; The Heart Hospital of Sao Paulo, Sao Paulo, Brazil.; PROADI-Ministry of Health, Sao Paulo, Brazil.; Gestar Fetal Surgery Center, Sao Paulo, Brazil., Vergote S; My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Women and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium., Lewi L; My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Women and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.; Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium., Filippo MOL; The Heart Hospital of Sao Paulo, Sao Paulo, Brazil.; PROADI-Ministry of Health, Sao Paulo, Brazil.; Gestar Fetal Surgery Center, Sao Paulo, Brazil., McCulloch P; IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.; IDEAL Collaboration, Nuffield Department of Surgery, Oxford University Hospitals, John Radcliffe Hospital, Oxford, UK., Devlieger R; My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Women and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.; Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium., Peralta CFA; The Heart Hospital of Sao Paulo, Sao Paulo, Brazil.; PROADI-Ministry of Health, Sao Paulo, Brazil.; Gestar Fetal Surgery Center, Sao Paulo, Brazil., Deprest J; My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Women and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.; Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.; Institute for Women's Health, University College London, London, UK.
Jazyk: angličtina
Zdroj: Prenatal diagnosis [Prenat Diagn] 2024 May; Vol. 44 (5), pp. 644-652. Date of Electronic Publication: 2024 Mar 19.
DOI: 10.1002/pd.6547
Abstrakt: Objective: To investigate whether prenatal repair of spina bifida aperta through mini-hysterotomy results in less prematurity, as compared to standard hysterotomy, when adjusting for known prematurity risks.
Methods: We performed a bi-centric, propensity score matched, controlled study, that is, adjusting for factors earlier reported to result in premature delivery or membrane rupture, in consecutive women having prenatal repair either through stapled hysterotomy or sutured mini-hysterotomy (≤3.5 cm). Matches were pairwise compared and cox-regression analysis was performed to define the hazard ratio of delivery <37 weeks.
Results: Of 346 meeting the MOMS-criteria, 78 comparable pairs were available for matched-controlled analysis. Mini-hysterotomy patients were younger and had a higher BMI. Mini-hysterotomy was associated with a 1.67-lower risk of delivery <37 weeks (hazard ratio: 0.60; 95% CI: 0.42-0.85; p = 0.004) and 1.72 for delivery <34 + 6 weeks (hazard ratio: 0.58; 95% CI: 0.34-0.97; p = 0.037). The rate of intact uterine scar at birth (mini-hysterotomy: 98.7% vs. hysterotomy: 90.4%; p = 0.070), the rate of reversal of hindbrain herniation within 1 week after surgery (88.9% vs. 97.4%; p = 0.180) and the rate of cerebrospinal fluid leakage (0% vs. 2.7%; p = 0.50) were comparable.
Conclusion: Prenatal spina bidifa repair through mini-hysterotomy was associated with a later gestational age at delivery and a comparable intact uterus rate without apparent compromise in neuroprotection.
(© 2024 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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