American journal of obstetrics and gynecologyReview
19 Feb 2025
Prenatal repair of open spina bifida has become well-established. Several surgical approaches have emerged, each focused on optimizing outcomes while minimizing risks. This study aims to compare the gestational age at delivery following the various surgical techniques.
This systematic review and meta-analysis synthesizes data from 37 studies between 2010 and 2023.
Eligible studies included pregnant patients diagnosed with open spina bifida who underwent the following intrauterine repair techniques: open, mini-hysterotomy, laparotomy-assisted fetoscopic, and percutaneous fetoscopic repair.
The primary outcome investigated was gestational age (GA) at delivery, while secondary outcomes were preterm premature rupture of membranes (PPROM), vaginal birth, and perinatal mortality. The programming language software R (version 4.0.5) was used to execute the analysis.
In this meta-analysis, 2,333 prenatal repair of open spina bifida procedures arising from 14 countries were analyzed. Of these, open repair accounted for 65.7%, mini-hysterotomy 14.4%, laparotomy-assisted fetoscopic 5.36%, and percutaneous fetoscopic 14.6%. Subgroup analyses revealed a non-significant mean GA at birth:34 weeks for open repair, 34 weeks for mini-hysterotomy, 35 weeks for laparotomy-assisted, and 32 weeks for percutaneous fetoscopic method (p=0.26). While the GA at birth was not different, there were significant differences (P<0.01) in pooled proportions of PPROM and preterm birth by surgical approach. (Overall rates: 75% and 30% respectively). Vaginal birth rates had significant subgroup differences (P<0.01), with the laparotomy-assisted fetoscopic group more likely to have vaginal deliveries (0.02, 0.04, 0.49, 0.18 for open, mini, laparotomy, and percutaneous, respectively).
The advanced secondary Bayesian analysis of data from this meta-analysis suggests that the mean gestational age at birth may differ among the four surgical techniques for prenatal repair of open spina bifida, with a potential advantage for the decrease in preterm births associated with a laparotomy-assisted approach. However, these findings should be interpreted cautiously, and further direct comparison studies are needed to confirm these observations.
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