Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Jodi Freeman

Abstract

Introduction: There have been great advances in the treatment of myelomeningocele (MMC) spina bifida in the past 20 years. An open surgical repair in-utero has been shown to reduce mortality and morbidity, specifically decreasing the rate of shunt placement and hindbrain herniation compared to a postnatal surgical approach. However, this surgery introduced risks to the mother that were never a consideration in previous surgical approaches.

Methods: This paper compares research on new minimally invasive fetoscopic surgical techniques to open fetal surgery in the prenatal repair of MMC. Searches in PubMed and Clinical Key were conducted to produce papers published on the topic within the last 10 years.

Results: The open fetal repair has associated risks to both the mother and child. New research shows that there are risks for the mother that extend beyond their current pregnancy. Research shows an increased risk of uterine rupture in subsequent pregnancies after an open fetal approach. A minimally invasive procedure may be the solution that could decrease risks and side effects associated with open fetal surgery. Preliminary studies show that a fetoscopic repair has demonstrated similar rates of shunt placement to patients who received open repair.

Discussion: Despite these promising results, the data is limited and the surgical technique is inconsistent. More research is needed into finding the best approach for fetoscopic repair. Once the procedure becomes standardized, a double blind clinical trial to compare fetoscopic and open repairs should be conducted.

Additional Files

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Comparing Open and Fetoscopic Fetal Surgical Repairs of Myelomeningocele

Introduction: There have been great advances in the treatment of myelomeningocele (MMC) spina bifida in the past 20 years. An open surgical repair in-utero has been shown to reduce mortality and morbidity, specifically decreasing the rate of shunt placement and hindbrain herniation compared to a postnatal surgical approach. However, this surgery introduced risks to the mother that were never a consideration in previous surgical approaches.

Methods: This paper compares research on new minimally invasive fetoscopic surgical techniques to open fetal surgery in the prenatal repair of MMC. Searches in PubMed and Clinical Key were conducted to produce papers published on the topic within the last 10 years.

Results: The open fetal repair has associated risks to both the mother and child. New research shows that there are risks for the mother that extend beyond their current pregnancy. Research shows an increased risk of uterine rupture in subsequent pregnancies after an open fetal approach. A minimally invasive procedure may be the solution that could decrease risks and side effects associated with open fetal surgery. Preliminary studies show that a fetoscopic repair has demonstrated similar rates of shunt placement to patients who received open repair.

Discussion: Despite these promising results, the data is limited and the surgical technique is inconsistent. More research is needed into finding the best approach for fetoscopic repair. Once the procedure becomes standardized, a double blind clinical trial to compare fetoscopic and open repairs should be conducted.

 
 

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