Context Intrauterine closure of exposed spinal cord tissue prevents secondary
neurologic injury in animals with a surgically created spinal defect; however,
whether in utero repair of myelomeningocele improves neurologic outcome in
infants with spina bifida is not known.
Objective To determine whether intrauterine repair of myelomeningocele improves
patient outcomes compared with standard care.
Design Single-institution, nonrandomized observational study conducted between
January 1990 and February 1999.
Setting Tertiary care medical center.
Participants A sample of 29 study patients with isolated fetal myelomeningocele referred
for intrauterine repair that was performed between 24 and 30 gestational weeks
and 23 controls matched to cases for diagnosis, level of lesion, practice
parameters, and calendar time. All infants were followed up for a minimum
of 6 months after delivery.
Main Outcome Measures Requirement for ventriculoperitoneal shunt placement, obstetrical complications,
gestational age at delivery, and birth weight for study vs control subjects.
Results The requirement for ventriculoperitoneal shunt placement for decompression
of hydrocephalus was significantly decreased among study infants (59% vs 91%; P = .01). The median age at shunt placement was also older
among study infants (50 vs 5 days; P = .006). This
may be explained by the reduced incidence of hindbrain herniation among study
infants (38% vs 95%; P<.001). Following hysterotomy,
study patients had an increased risk of oligohydramnios (48% vs 4%; P = .001) and admission to the hospital for preterm uterine
contractions (50% vs 9%; P = .002). The estimated
gestational age at delivery was earlier for study patients (33.2 vs 37.0 weeks; P<.001), and the birth weight of study neonates was
less (2171 vs 3075 g; P<.001).
Conclusions Our study suggests that intrauterine repair of myelomeningocele decreases
the incidence of hindbrain herniation and shunt-dependent hydrocephalus in
infants with spina bifida, but increases the incidence of premature delivery.