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Oral Concurrent Session 8 - Fetus and Fetal Intervention

Oral Concurrent Sessions

Oral Concurrent Session 8 - Fetus and Fetal Intervention

(92) Effect of very preterm delivery on outcomes following in-utero spina bifida repair

Saturday, February 1, 2025
9:30 AM – 9:45 AM  
Location: Aurora Ballroom B, Lobby Level
Objective: In-utero fetal spina bifida repair decreases the risk for ventriculoperitoneal shunt (VP shunt) placement, reverses hindbrain herniation, and improves motor function with a higher likelihood of independent ambulation. The goal of this project was to assess pregnancy and neonatal outcomes among individuals who delivered very preterm (< 30 weeks of gestation (wk)) from the fMMC Consortium Registry sponsored by the North American Fetal Therapy Network (NAFTNet).

Study Design: The NAFTNet fMMC registry includes prospectively collected data from 2011 to 2024. Three cohorts of patients were categorized by gestational age (GA) of delivery and compared: < 30 wk, 30-34 wk, and > 34 wk.  Comparisons between groups for maternal and delivery outcomes were completed for the entire cohort and then analyzed for those with available shunt data. Chi-square or Fisher’s exact tests were used to compare categorical variables, and Kruskal-Wallis tests were used to compare continuous variables. p-values < 0.05 were considered significant.

Results: A total of 1,213 patients were available for analysis (< 30 wk n=111, 30-34 wk n=323, >34 wk n=779).  Overall mortality was 2.2%, 85% of which occurred in the < 30 wk cohort (Table 1) in which perinatal mortality was 21%. Latency from fetal surgery to delivery averaged 2.6 wks for the < 30 wk group. Rates of abruption, chorioamnionitis, and spontaneous labor were higher compared to later GA cohorts. Neonatal morbidity was also significantly higher for sepsis, apnea, respiratory distress, patent ductus arteriosus, and periventricular leukomalacia in the < 30 wk cohort. VP shunt data was available for 677 patients (< 30 wk n=53, 30-34 wk n=186, >34 wk n=438). A similar rate of VP shunt placement was seen between GA groups (Table 2). 

Conclusion:

Very preterm birth following in-utero spina bifida repair results in significant perinatal mortality and neonatal morbidity.  Despite very preterm birth, the reduction in VP shunt rates, a benefit of in utero repair, appears to be preserved.  Further data is required to analyze the impact on ambulation and developmental outcomes.