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Open Fetal Surgery for Myelomeningocele (Spina Bifida) Repair Outcomes

Physicians affiliated with The Fetal Center at Children’s Memorial Hermann Hospital and McGovern Medical School at UTHealth were the first in the Southwestern United States to perform open fetal surgery for the repair of myelomeningocele (MMC), the most severe form of spina bifida, in May 2011. This procedure followed the announcement of published results from the seven-year multicenter clinical trial, the Management of Myelomeningocele Study (MOMS), in March 2011.

The data below is an overview of The Fetal Center’s clinical outcomes data, from May 2011 – May 2016, for fetal MMC repair. Overall, 143 women were evaluated at The Fetal Center and 44 patients met criteria for fetal surgery.  Of the 44 qualifying patients, 32 patients elected to undergo fetal surgery repair.

In the MOMS trial, 299 patients were referred to one of three fetal centers for screening and evaluation; 183 patients were randomized and 80 patients underwent postnatal surgical repair.  Seventy-eight patients qualified for fetal surgery and 77 patients underwent fetal surgery for MMC repair.

Overall, The Fetal Center’s outcomes data mirrors those reported in the MOMS trial.  For more information or to speak with a clinician at The Fetal Center, call 832.325.7288 or email thefetalcenter@memorialhermann.org.

Download our outcomes data »

Spina Bifida Repair – Overview

The table below provides a comprehensive overview of The Fetal Center’s fetal MMC repair outcomes as compared to the MOMS trial.

Note: The following data reflects The Fetal Center’s surgical volume from May 2011 – May 2016 and represents outcomes for 32 patients who have undergone open fetal surgery for MMC repair.

Spina-Bifida-Overview

Gestational Age at Delivery

Mothers who undergo open fetal surgery for MMC repair are carefully followed by the multidisciplinary team at The Fetal Center through the remainder of their pregnancy, with a scheduled C-section delivery at 37 weeks.  For The Fetal Center patients, the mean gestational age at delivery is 34.5 weeks, the median is 35.3 weeks, and the range is 11.9 weeks.  The graph below reflects The Fetal Center’s gestational age at delivery outcomes data as compared to the MOMS trial. 

Overall, 31 percent of mothers treated at The Fetal Center delivered past 37 weeks gestation as compared to 21 percent in the MOMS trial. Delivery after 37 weeks gestation serves as a benefit to the health and long-term outcome of the baby, according to the American College of Obstetrics and Gynecology.

Note: The following data reflects The Fetal Center’s surgical volume from May 2011 – May 2016 and represents outcomes for 32 patients who have undergone open fetal surgery for MMC repair.

Spina-Bifida-Gestational-Age-at-Delivery

Maternal Complications

The affiliated physicians at The Fetal Center make significant efforts to eliminate or minimize any potential patient complications related to fetal surgery. The graph below reflects The Fetal Center’s outcomes data for maternal complications as compared to the MOMS trial.  For most of the conditions considered, The Fetal Center had a lower complication rate than the MOMS trial. 

Note: The following data reflects The Fetal Center’s surgical volume from May 2011 – May 2016 and represents outcomes for 31 patients who have undergone open fetal surgery for MMC repair. Maternal complications data for one patient of The Fetal Center is still pending.

Spina-Bifida-Maternal-Complications

Status of Hysterotomy Site

At The Fetal Center, patient safety is our top priority. The affiliated physicians use their experience and expertise to perform the surgical repair on the fetus, while also protecting the mother’s health and safety simultaneously. It is our goal that every mother who undergoes this procedure recovers fully from the operation, while minimizing future complications. The graph below reflects the known outcomes for The Fetal Center patients as compared to the MOMS trial, specifically detailing the status of the mothers’ hysterotomy site – an incision in the uterus required to perform open fetal surgery – at the time of delivery. 

Overall, 91 percent of mothers treated at The Fetal Center had a hysterotomy site that was intact and well-healed, similar to those of a classic cesarean section, as compared to 64 percent in the MOMS trial. The Fetal Center cohort showed lower percentages of complications related to the hysterotomy than the MOMs trial cases, and none that resulted in a complete dehiscence (or wound rupture).

Note: The following data reflects The Fetal Center’s surgical volume from May 2011 – May 2016 and represents outcomes for 32 patients who have undergone open fetal surgery for MMC repair.

Spina-Bifida-Status-of-Hysterotomy

Neonatal Outcomes & VP Shunt Rate

The following data reflects The Fetal Center’s surgical volume from May 2011 – May 2016 and represents outcomes for the number of patients who have undergone open fetal surgery for MMC repair. Information on dehiscence and hindbrain herniation is not available for one patient of The Fetal Center.  Also included are reported outcomes from The Fetal Center and the MOMS trial showing the total number of patients who have undergone open fetal surgery for MMC repair, who have also received a ventriculoperitoneal (VP) shunt by 12 months of age.

Spina-Bifida-Shunt

The data represents patient volume from May 2011 through May 2016.
Published January 2017.

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