(145) Maternal laparotomy to fetoscopic MMC repair in the morbidly obese is safe and feasible

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Braxton Forde, MD

Assistant Professor
University of Cincinnati College of Medicine
Cincinnati, OH, United States

Coauthor(s)

KN

K. Schuyler Nissen, BS

Medical Student
University of Cincinnati College of Medicine
Cincinnati, Ohio, United States
CS

Charles Stevenson, MD

Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
Foong-Yen Lim, MD (he/him/his)

Surgical Director of Fetal Care Center, Professor of Pediatric Surgery
Cincinnati Children's Hospital
Cincinatti, Ohio, United States
MH

Mounira Habli, MD

Associate Professor
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
David McKinney, MD (he/him/his)

Assistant Professor
University of Cincinnati College of Medicine
Cincinnati, Ohio, United States
EG

Erinn Goetz, RN

Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
Jose L. Peiro, MBA, MD, PhD

Program Director
Cincinnati Children's Fetal Care Center
Cincinnati, Ohio, United States

Objective: The Management of Myelomeningocele Study (MOMS) delineated inclusion and exclusion criteria for in utero myelomeningocele (MMC) repair. One exclusion was maternal BMI > 35 kg/m. Our institution expanded the criteria to include body mass index (BMI) up to 39.99. Concerns have been raised regarding fetoscopic MMC repair and the prolonged operative time in the morbidly obese, therefore, we sought to evaluate the outcomes of fetoscopic MMC repair in the setting of BMI ≥ 35 at the time of surgery.

Study Design: This was an IRB-approved, single institution study from 2016-2024. Inclusion criteria were any patients that underwent fetoscopic repair at our institution that had a BMI of at least 35.0 on the date of surgery. These patients all had a midline laparotomy to 3 port fetoscopic MMC repair (Figure 1). All patients underwent 3-layer closure, with 2 overlapping human umbilical cord matrix patches and either primary skin closure or skin patch placement. Outcomes assessed were operative time, gestational age at delivery, route of delivery, need for cerebrospinal fluid (CSF) diversion at 12 months, and postoperative complications.

Results: During study window, 92 patients underwent maternal laparotomy to fetoscopic MMC repair. Of those 92, 19 had a BMI ≥ 35 as documented in the medical record at the date of surgery. The median gestational age at surgery was 25 2/7 weeks (IQR 24 6/7, 25 5/7), median gestational age at delivery was 35 3/7 weeks (IQR 34 1/7, 36 5/7), and CSF diversion rate at 12 months was 31.3%, which were similar to better than outcomes with BMI < 35 (Table 1). The rate of vaginal delivery was 42%, also similar to those with BMI < 35. Interestingly, total OR time was no different with respect to BMI (OR time 255 min, IQR 235.5, 294 in BMI ≥ 35 vs 251, IQR 230, 297 in BMI < 35, p = 0.707).

Conclusion: Maternal BMI 35-< 40 did not negatively affect the pregnancy or postoperative outcomes in the setting of fetoscopic MMC repair. Further evaluation of fetoscopic MMC outcomes in the setting of maternal BMI of 40-45 may be warranted.