Risk factors for preterm birth following open fetal myelomeningocele repair – results from a prospective cohort

Aim:

Fetal myelomeningocele (fMMC) repair is a therapeutic option in selected cases. The total duration of fetal surgery and the occurrence of oligohydramnios before PPROM are reported risk factors for preterm delivery. This study aimed at the identification of risk factors for preterm birth following open fMMC repair.

Materials and methods:

Sixty-seven women underwent fMMC repair between 2010 and 2017 at our center. Demographic, surgical, and pregnancy complications, including potential risk factors for preterm birth (GA < 37 weeks) such as preterm premature rupture of membranes (PPROM), chorioamniotic membrane separation (CMS) and placental abruption were evaluated using Chi Square test and t-test.

Results:

Maternal Body Mass Index, maternal age, parity, previous uterine surgery, GA at intrauterine surgery, total surgery time, surgical subcutaneous hematoma, oligohydramnios and amniotic fluid leakage were not identified as risk factors for preterm birth. However, complications directly attributed to the surgical interventions as CMS (p = 0.028, 92% vs. 52%) and PPROM (p = 0.001, 95% vs. 52%) were highly associated with preterm birth. Placental abruption was found more often after fMMC repair compared to a general obstetrical population (12% versus 1%) and ended in premature birth in all cases (p = 0.024, 100% vs. 60%). However the majority of women delivered at a gestational age > 35 weeks.

Conclusions:

In our study cohort, risk factors for preterm birth were PPROM, CMS and placental abruption, whereas surgery time did not influence our outcome. We conclude that the surgery technique should aim at minimizing CMS and amniotic fluid leakage.