Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
Obstet Gynecol. 2023 Mar 1;141(3):505-521. doi: 10.1097/AOG.0000000000005074. Epub 2023 Feb 2.
Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.
尽管在全国范围内对食物进行了叶酸强化，但神经管缺陷仍然是一种常见的中枢神经系统先天性异常，活产儿中的发病率为每 10000 例 2-4 例。对这种疾病进行产前筛查，为患者提供了在怀孕期间考虑各种治疗选择的机会。传统上通过剖腹术的开放式母婴手术来修复开放性脊柱裂，已被证明可以改善儿童的结局，包括减少对脑脊液分流手术的需求和改善下运动神经功能。然而，开放式母婴手术与患者和整个妊娠以及未来妊娠的风险增加有关。最近，通过胎儿镜进行的开放性脊柱裂微创产前修复的进展，为儿童带来了相似的益处，但对孕妇和未来生育的儿童的结局相对改善。
