Document Detail


Fetal myelomeningocele repair: short-term clinical outcomes.
MedLine Citation:
PMID:  14520222     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The study was undertaken to evaluate short-term clinical outcomes with antenatal myelomeningocele (MMC) repair. STUDY DESIGN: Retrospective review of 50 fetuses that underwent open fetal MMC closure was performed. Inclusion criteria included less than 26 weeks' gestation, thoracic to S1 level defect, absent clubfoot deformity, Arnold-Chiari malformation, ventriculomegaly less than 17 mm, normal karyotype, and no other anomalies. RESULTS: Perinatal survival was 94% (47/50 fetuses). Mean age at delivery was 34 weeks 3 days. All fetuses demonstrated reversal of hindbrain herniation. Forty-three percent of the 50 fetuses have required ventriculoperitoneal shunting compared with 100% thoracic, 88% lumbar, and 68% sacral (85% overall) in 297 historic controls. Better-than-predicted leg function was seen in 57% of thoracic and lumbar level lesion patients. CONCLUSION: Early experience with fetal MMC repair suggests a decreased need for ventriculoperitoneal shunting, arrest or slowing of progressive ventriculomegaly, and consistent resolution of hindbrain herniation. However, further long-term follow-up is needed to evaluate neurodevelopment and bladder and bowel function.
Authors:
Mark P Johnson; Leslie N Sutton; Natalie Rintoul; Timothy M Crombleholme; Alan W Flake; Lori J Howell; Holly L Hedrick; R Douglas Wilson; N Scott Adzick
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  189     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-10-01     Completed Date:  2003-10-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  482-7     Citation Subset:  AIM; IM    
Affiliation:
Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadephia, PA 19104, USA. johnsonma@email.chop.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Delivery, Obstetric
Female
Fetal Diseases / physiopathology,  surgery*
Gestational Age
Humans
Infant Mortality
Infant, Newborn
Leg / physiopathology
Lumbosacral Region
Meningomyelocele / embryology*,  physiopathology,  surgery*
Pregnancy
Pregnancy Outcome
Reoperation
Retrospective Studies
Survival Analysis
Thorax
Time Factors
Treatment Outcome
Ventriculoperitoneal Shunt

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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