Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil.
Disciplina de Neurocirurgia, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil.
Arch Gynecol Obstet. 2021 Dec;304(6):1443-1454. doi: 10.1007/s00404-021-06066-y. Epub 2021 May 1.
Myelomeningocele (MMC) is an open neural tube defect that causes great morbidity. Prenatal open repair is the standard treatment; however, there are many complications related to the procedure. This study reports preliminary findings of open in utero repair of MMC in a public tertiary hospital in Brazil and describes factors that could be associated with increased surgical morbidity.
Thirty-nine patients underwent open in utero repair of MMC from October 2015 to August 2019. The Clavien-Dindo classification of surgical complications and a classification system with the preterm definitions of the World Health Organization were used, respectively, for maternal and fetal complications.
A total of 28 mothers (71.8%) and 31 fetuses (79.5%) experienced at least one minor to major complication. Three mothers (7.7%) had a severe grade 4 complication. Fetal complications grades 3 to 5 occurred in 13 fetuses (33.3%). Gestational age at surgery and at birth were 24.88 ± 1.16 weeks and 33.23 ± 3.68 weeks, respectively. Preterm delivery occurred in 30 patients (76.9%), membrane rupture in 18 patients (46.2%) and chorioamnionitis in 13 patients (33.3%).
Open fetal surgery for MMC was performed at a Brazilian public tertiary care center, resulting in three grade 4 maternal complications. Relevant fetal complications were also present. The use of a standard classification system for complications renders studies more comparable and data more useful for counseling patients. Adjustments of perioperative procedures and long-term follow-up are needed to determine the real benefit of open in utero repair of MMC at our hospital.
脊髓脊膜膨出（MMC）是一种开放性神经管缺陷，会导致严重的发病率。产前开放性修复是标准治疗方法；然而，该手术有许多与手术相关的并发症。本研究报告了巴西一家公立三级医院进行的开放性宫内 MMC 修复的初步结果，并描述了可能与手术发病率增加相关的因素。
2015 年 10 月至 2019 年 8 月，39 例 MMC 患者接受了开放性宫内修复。采用 Clavien-Dindo 外科并发症分类和世界卫生组织的早产定义分类系统，分别对母婴并发症进行分类。
共有 28 名母亲（71.8%）和 31 名胎儿（79.5%）经历了至少一次轻微至严重并发症。3 名母亲（7.7%）出现严重 4 级并发症。13 名胎儿（33.3%）发生 3 至 5 级胎儿并发症。手术时和出生时的胎龄分别为 24.88±1.16 周和 33.23±3.68 周。30 名患者（76.9%）早产，18 名患者（46.2%）胎膜破裂，13 名患者（33.3%）绒毛膜羊膜炎。
巴西一家公立三级医疗中心对 MMC 进行了开放性胎儿手术，导致 3 例母亲出现 4 级并发症。还存在相关的胎儿并发症。使用并发症的标准分类系统使研究更具可比性，数据更有助于为患者提供咨询。需要调整围手术期程序和长期随访，以确定我院开放性宫内 MMC 修复的真正获益。
