Department of Surgery, University of California-Davis, Sacramento, California, USA,
Department of Surgery, University of California-Davis, Sacramento, California, USA.
Fetal Diagn Ther. 2020;47(6):507-513. doi: 10.1159/000505400. Epub 2020 Feb 25.
The ovine model is the gold standard large animal model of myelomeningocele (MMC); however, it has a high rate of fetal loss. We reviewed our experience with the model to determine risk factors for fetal loss.
We performed a retrospective review from 2009 to 2018 to identify operative factors associated with fetal loss (early fetal demise, abortion, or stillbirth). Operative risk factors included gestational age at operation, operative time, reduction of multiple gestations, amount of replaced amniotic fluid, ambient temperature, and method of delivery.
MMC defects were created in 232 lambs with an overall survival rate of 43%. Of the 128 fetuses that died, 53 (42%) had demise prior to repair, 61 (48%) aborted, and 14 (11%) were stillborn. Selective reduction of multiple gestations in the same uterine horn was associated with increased fetal demise (OR 3.03 [95% CI 1.29-7.05], p = 0.01). Later gestational age at MMC repair and Cesarean delivery were associated with decreased abortion/stillbirth (OR 0.90 [95% CI 0.83-0.90], p = 0.03, and OR 0.37 [95% CI 0.16-0.31], p = 0.02), respectively.
Avoiding selective reduction, repairing MMC later in gestation, and performing Cesarean delivery decreases the rate of fetal loss in the ovine MMC model.
羊膜动物模型是神经管缺陷（MMC）的金标准大型动物模型；然而，它的胎儿丢失率很高。我们回顾了我们在该模型中的经验，以确定与胎儿丢失相关的风险因素。
我们对 2009 年至 2018 年的病例进行了回顾性分析，以确定与胎儿丢失（早期胎儿死亡、流产或死产）相关的手术因素。手术危险因素包括手术时的胎龄、手术时间、多胎妊娠的减少、替代羊水的量、环境温度和分娩方式。
在 232 只羔羊中成功建立了 MMC 缺陷，总存活率为 43%。在 128 只死亡的胎儿中，有 53 只（42%）在修复前死亡，61 只（48%）流产，14 只（11%）死产。同一子宫角的选择性多胎妊娠减少与胎儿死亡增加相关（OR 3.03[95%CI 1.29-7.05]，p = 0.01）。MMC 修复时的胎龄较大和剖宫产与流产/死产减少相关（OR 0.90[95%CI 0.83-0.90]，p = 0.03，和 OR 0.37[95%CI 0.16-0.31]，p = 0.02）。
避免选择性减少、在妊娠晚期修复 MMC 和进行剖宫产可降低羊膜动物 MMC 模型中的胎儿丢失率。
