Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.
J Pediatr Surg. 2013 May;48(5):951-5. doi: 10.1016/j.jpedsurg.2013.02.010.
The purpose of this manuscript was to examine the maternal morbidity and reproductive outcomes following maternal-fetal surgery with an emphasis on the EXIT procedure.
The medical records of all women who underwent an ex-utero intrapartum treatment (EXIT) procedure or mid-gestation open maternal fetal surgery (OMFS) at our center from December 2001 to December 2011 were reviewed retrospectively. Future reproductive outcomes were obtained via telephone questionnaire.
Thirty-three women underwent maternal-fetal surgery. Twenty-six had EXIT, and seven had OMFS. The questionnaire response was 82% (27/33). Eighty-one percent (17/21) of the EXIT cohort desired future pregnancy. All who attempted (13/13) were successful. The majority (85%) conceived spontaneously and within 2.5 years on average. In the OMFS group, 40% experienced complications. One had uterine dehiscence, and another had uterine rupture requiring urgent delivery at 36 weeks. In subsequent pregnancies, 20% of OMFS cases were complicated by uterine rupture, and 8% of EXIT patients had uterine dehiscence. All had good maternal-fetal outcome.
Future reproductive capacity and complication rates in subsequent pregnancies following EXIT procedure are similar to those seen in the general population. In contrast, mid-gestation OMFS remains associated with relatively morbid complications. This evidence can help guide in counseling expectant mothers who are faced with the challenge of considering fetal surgery.
本研究旨在探讨胎儿手术（尤其是经子宫外产时处理术，EXIT）后的产妇发病率和生殖结局。
回顾性分析 2001 年 12 月至 2011 年 12 月在本中心接受经子宫外产时处理术或妊娠中期开腹胎儿手术（OMFS）的所有女性的病历。通过电话问卷调查获得未来的生殖结局。
33 名女性接受了胎儿手术。26 例行 EXIT，7 例行 OMFS。问卷调查的回复率为 82%（27/33）。21 例 EXIT 组中有 81%（17/21）希望再次妊娠。所有尝试（13/13）的人都成功了。大多数（85%）是自然受孕，平均在 2.5 年内受孕。在 OMFS 组中，40%出现并发症。1 例出现子宫破裂，另 1 例因子宫破裂在 36 周时紧急分娩。随后的妊娠中，20%的 OMFS 病例出现子宫破裂，8%的 EXIT 病例出现子宫破裂。所有母婴结局均良好。
EXIT 手术后的未来生育能力和后续妊娠的并发症发生率与一般人群相似。相比之下，妊娠中期 OMFS 仍然与相对严重的并发症相关。这些证据可以帮助指导面临胎儿手术挑战的孕妇进行咨询。
