Perinatal results of intrauterine open fetal surgery of fetuses diagnosed with myelomeningocoele – the clinical report of ten cases

The purpose of the study was to demonstrate our approach to qualification for open fetal surgery (OFS) and surgery techniques. We also tried to determinate the outcome of fetal surgical treatment. OFS was performed in 10 out of 15 cases with prenataly diagnosed myelomeningocele. Patients were qualified for the surgery on the basis of precisely determined inclusion criteria and after assessment by multidisciplinary team of specialists. Surgery was performed between 22nd and 29th week of pregnancy. Fist and second surgery were performed in 29th and 27th week of pregnancy, some patients have undergone the surgery before 26th week of pregnancy. Babies were delivered by cesarean section. Gestational age by the time of the delivery ranged from 25th and 37th and a half week of pregnancy. In two cases the delivery was at term. Main complications included: PROM, placental ablation and vaginal bleeding. In half of all the cases we did not observe hydcephalus increase after the surgery. OFS can be beneficial but it can also carry certain amount of risk both for the fetus and the mother. Therefore, further randomized research deems necessary to better comprehend and determine the safety and effectiveness of such procedures

Diagnostics and therapy of fetal malformations – current knowledge and practice

Fetal diagnostics and therapy is a new, intensively developing branch of medicine. Thanks to prenatal diagnosis, we are able to determine the most advantageous time, location and method of delivery. We can inform the parents and discuss a postnatal treatment plan. We currently have a wide range of diagnostic opportunities: biochemical analyzes, ultrasonography, echography, doppler ultra-sonography, magnetic resonance imaging as well as more invasive studies such as amniocentesis and cordocentesis. Fetal interventions are also possible in some selected cases. These include amniotic shunting, fetoscopy and operations with opening the uterus. These procedures are currently performed in cases of congenital cystic adenomatoid malformation, diaphragmatic hernia, hydrocephalus, myelomeningocele twin-to-twin transfusion syndrome and others. The indications for fetal intervention are the threat of fetal death and essential developmental disorders. Fetal procedures also allow us to reduce a child's disability. It should be emphasized that the postnatal period is still the best time for operations on developmental abnormalities. Prenatal procedures remain at the stage of clinical studies and should be performed only in selected, highly specialized centers.Diagnostyka i terapia wad płodu to nowa, burzliwie rozwijająca się gałąź medycyny. Prenatalne rozpoznanie wady pozwala ustalić najkorzystniejszy czas, miejsce i drogę porodu. Można poinformować rodziców i uzgodnić z nimi plan i zakres leczenia po urodzeniu. Dysponujemy obecnie szeroką gamą możliwości diagnostycznych, od badań biochemicznych i USG począwszy, przez echo serca, doppler-USG, rezonans magnetyczny, na badaniach inwazyjnych, czyli amniopunkcji i kordocentezie, skończywszy. W wybranych przypadkach możliwe są również interwencje płodowe. Należą do nich: szantowanie, czyli łączenie jam ciała z jamą owodni, fetoskopia oraz operacje na otwartej macicy. Współcześnie zabiegi te wykonuje się m.in. w przypadkach: torbielowatości płuc, przepukliny przeponowej, wodogłowia, przepukliny oponowo-rdzeniowej oraz zespołu podkradania w ciąży bliźniaczej. Wskazaniem do interwencji płodowej jest zagrożenie życia płodu, istotne zaburzenie jego rozwoju lub możliwość zmniejszenia zakresu kalectwa. Należy podkreślić, że nadal najlepszym czasem do leczenia wad rozwojowych jest okres po urodzeniu. Interwencje płodowe pozostają na etapie nabywania doświadczeń i powinny być wykonywane tylko w wybranych, wysoko wyspecjalizowanych ośrodkach

Prenatal surgery for spina bifida: a therapeutic dilemma. Proceedings of the SHINE conference, Belfast

This is a transcript of a scientific conference on the subject of prenatal surgery for spina bifida. It represents the views of three patients, an obstetrician, a postnatal neurosurgeon, a neonatologist, a paediatric neurologist, two surgeons who practice open spina bifida foetal surgery, a fetoscopic surgeon and an obstetrician experienced in randomised trials and systematic reviews. Implications for current practice and recommendations for future research are also discussed in detail