Intrauterine Fetoscopic Repair of Myelomeningocele: 30-Month Follow-up Data

Background: The MOMS trial demonstrated that intrauterine open repair of MMC after hysterotomy results in marked improvement of motor and mental milestones and greatly reduces VP-shunt placement. A less invasive procedure is resembled by a total percutaneous intrauterine fetoscopic repair, which reduces risks like uterus rupture and enables transvaginal deliveries in subsequent pregnancies.

Methods: From 2010 to 2014, a group of 72 children received percutaneous intrauterine repair of MMC in Giessen. 52 (72%) were reinvestigated up to 30 months after the procedure. Mortality data are available for all operated children. Included children were assessed at four time points: (1) directly after birth, (2) at age 3 months, (3) at age 12 months, and (4) 30 months of corrected age.

Results: All children survived the intrauterine procedure. However, postnatally four children (5.5%) died. 11.7% were born before the 30th gestational week. Shunt placement took place in 48% of the intrauterine operated children. Free ambulation without assistance was possible for 46% at the age of 30 months. Bayley scales exceeding 70% were reached by 70% of children for MDI and 80% for BDI.

Conclusion: Considering mortality, gross motor function, mental scores and VP-Shunt rate, intrauterine repair by fetoscopy or open repair (MOMS trial) results in a comparable outcome. Results of our study are restricted by its retrospective nature. Additionally, in our fetoscopic study only children with at least partially retained leg movement were included. This was not a necessary inclusion criterion in the moth trial.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 October 2021