OC16.05: Open fetal surgery for congenital malformations: feasibility and perinatal outcomes

Open fetal surgery became standard of care for myelomeningocele (MMC) after the MOMS trial and have encouraged many centres to enable them to be performed this procedure and broadening their indications. We reviewed the outcomes from our centre for MMC repair and others fetal conditions including data from surgery and perinatal period. A total of 211 open fetal surgeries were performed including 203 myelomeningoceles according MOMS criteria; Encephalocele (4); Congenital high airway obstruction syndrome (2); Congenital cystic adenomatoid malformation (1) and cervical myelomeningocele (1) using an alternative surgical approach developed in our institution during the last five years. The surgeries were undertaken with the same team with expertise in open fetal surgical and prepared to handle maternal and fetal complications. All procedures were performed as scheduled and there was no maternal death. Myelomeningocele: GA at surgery 25 weeks (24–26); Surgery time 117 minutes (106–148); Interval between surgery and birth 52.9 days (5–89); Preterm labour 17.1%; PROM 20.6%; Placental abruption 1.0%; Dehiscence of uterine suture 3.5%; GA at delivery 34 weeks (26–37); GA <30 weeks 6.0%; Weight 2,210g (680–3,515); Perinatal death 1,9%; Reversal of hindbrain herniation at birth 72.9% and ventriculoperitoneal shunt insertion 2.5%. Other fetal anomalies: GA at surgery 25 weeks (24–27); Surgery time 141 minutes (113–168); Interval between surgery and birth 48.6 days (7–71); Preterm labour 25%; PROM 37.5%; GA at delivery 33 weeks (25–36); GA <30 weeks 12.5%; Weight 2,138g (1,115-3,035). There was no placental abruption, dehiscence of uterine suture and perinatal death. This experience using a novel surgical technique for open fetal surgery showed similar results of MOMS trial for myelomeningocele repair without the stapler device and, also proved to be safe and effective for other indications not included in the MOMS criteria and for others fetal anomalies.