Open intrauterine repair of spina bifida aperta: Historical aspects, current availability, and clinical outcomes from the Latin American Spina Bifida Consortium. (1st July 2021) - Sepulveda, Waldo
Abstract: Objective: To determine the historical aspects, current availability, and clinical outcomes of open intrauterine repair of spina bifida aperta (IRSBA) in Spanish‐speaking Latin American countries. Methods: Cases were collected from centers with at least 2 years of experience and a minimum of 10 open IRSBA interventions by December 2020. Clinical variables were compared to the results of the Management of Myelomeningocele Study (MOMS) trial. Results: Clinical experience with 314 cases from seven centers was reviewed. Most cases ( n = 189, 60.2%) were performed between 24 and 25.9 weeks' gestation. Delivery at less than 30 weeks' gestation occurred in 36 cases (11.5%) and the overall perinatal mortality rate was 5.4% (17 of 314). The rate of maternal complications was low, including the need for blood transfusion ( n = 3, 0.9%) and dehiscence or a thin uterine scar ( n = 4, 1.3%). No cases of maternal death were recorded. Fifteen neonates required additional surgical repair of the spinal defect (4.8%) and 63 of 167 infants (37.7%) required a cerebrospinal fluid diversion procedure. Only two of the seven centers reported preliminary experience with fetoscopic IRSBA. Conclusions: Clinical experience and outcomes were within the expected results reported by the MOMS trial. There is still very limited experience with fetoscopic IRSBA in this part of the world. Key points: What is already known about this topic? Intrauterine repair of spina bifida aperta (IRSBA) is a well‐established option for the management of second‐trimester fetuses affected by this neural tube defect. Aside from Brazil, there is little information available on outcomes from fetal surgery centers in Latin America. What does this study add? The combined experience with 314 cases of IRSBA from the largest fetal surgery centers in Spanish‐speaking Latin America is presented. This study demonstrates the wide availability of, and experience with, open IRSBA in Hispanic America, with results comparable to those reported by the Management of Myelomeningocele Study trial. Historical aspects and a detailed register of centers performing fetal surgery are documented.