UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom.
Department of Obstetrics and Gynaecology, Fetal Medicine Unit, University Hospitals KU Leuven, Leuven, Belgium.
JAMA Netw Open. 2023 Apr 3;6(4):e239855. doi: 10.1001/jamanetworkopen.2023.9855.
Globally accepted recommendations suggest that a woman should be between 19 weeks and 25 weeks plus 6 days of pregnancy to be considered eligible for fetal closure of open spina bifida. A fetus requiring emergency delivery during surgery is therefore potentially considered viable and thus eligible for resuscitation. There is little evidence, however, to support how this scenario is addressed in clinical practice.
To explore current policy and practice for fetal resuscitation during fetal surgery for open spina bifida in centers undertaking fetal surgery.
DESIGN, SETTING, AND PARTICIPANTS: An online survey was designed to identify current policies and practices in place to support fetal surgery for open spina bifida, exploring experiences and management of emergency fetal delivery and fetal death during surgery. The survey was emailed to 47 fetal surgery centers in 11 countries where fetal spina bifida repair is currently performed. These centers were identified through the literature, the International Society for Prenatal Diagnosis center repository, and an internet search. Centers were contacted between January 15 and May 31, 2021. Individuals volunteered participation through choosing to complete the survey.
The survey comprised 33 questions of mixed multiple choice, option selection, and open-ended formats. Questions explored policy and practice supporting fetal and neonatal resuscitation during fetal surgery for open spina bifida.
Responses were obtained from 28 of 47 centers (60%) in 11 countries. Twenty cases of fetal resuscitation during fetal surgery during the last 5 years were reported across 10 centers. Four cases of emergency delivery during fetal surgery after maternal and/or fetal complications during the last 5 years were reported across 3 centers. Fewer than half the 28 centers (n = 12 [43%]) had policies in place to support practice in the event of either imminent fetal death (during or after fetal surgery) or the need for emergency fetal delivery during fetal surgery. Twenty of 24 centers (83%) reported preoperative parental counseling on the potential need for fetal resuscitation prior to fetal surgery. The gestational age at which centers would attempt neonatal resuscitation after emergency delivery varied from 22 weeks and 0 days to more than 28 weeks.
In this global survey study of 28 fetal surgical centers, there was no standard practice about how fetal resuscitation or subsequent neonatal resuscitation was managed during open spina bifida repair. Further collaboration between professionals and parents is required to ensure sharing of information to support knowledge development in this area.
全球公认的建议表明，女性应在怀孕 19 周到 25 周加 6 天之间，方可被视为有资格进行胎儿开放性脊柱裂闭合术。因此，如果手术期间需要紧急分娩的胎儿具有潜在生存能力，就有资格进行复苏。然而，几乎没有证据支持这种情况在临床实践中是如何处理的。
探讨在进行胎儿开放性脊柱裂修复的胎儿手术中心，对胎儿手术期间胎儿复苏的现行政策和实践。
设计、地点和参与者：设计了一项在线调查，以确定目前支持开放性脊柱裂胎儿手术的政策和实践，探讨紧急胎儿分娩和手术期间胎儿死亡的经验和管理。这项调查于 2021 年 1 月 15 日至 5 月 31 日期间通过电子邮件发送给 11 个目前正在进行胎儿脊柱裂修复的国家的 47 个胎儿手术中心。这些中心是通过文献、国际产前诊断学会中心资料库和互联网搜索确定的。中心之间进行了联系。个人自愿通过选择完成调查来参与。
该调查由 33 个多项选择题、选项选择和开放式格式的问题组成。这些问题探讨了在胎儿开放性脊柱裂修复期间进行胎儿手术时支持胎儿和新生儿复苏的政策和实践。
在 11 个国家的 47 个中心中，有 28 个中心（60%）做出了回应。在过去 5 年的 10 个中心中，有 20 例胎儿手术期间进行了胎儿复苏。在过去 5 年的 3 个中心中，有 4 例在母亲和/或胎儿出现并发症后，在胎儿手术期间进行了紧急分娩。在 28 个中心中，不到一半（n=12[43%]）制定了政策，以支持在胎儿手术期间或之后胎儿即将死亡（或在胎儿手术期间需要紧急分娩）的情况下开展实践。24 个中心中的 20 个（83%）报告说，在胎儿手术前对父母进行了潜在需要胎儿复苏的术前咨询。中心在紧急分娩后尝试对新生儿进行复苏的胎龄从 22 周零 0 天到超过 28 周不等。
在这项针对 28 个胎儿外科中心的全球调查研究中，对于开放性脊柱裂修复期间如何管理胎儿复苏或随后的新生儿复苏，没有标准的实践。需要专业人员和家长之间进一步合作，以确保分享信息，从而支持该领域知识的发展。
