Background

In utero closure of meningomyelocele using an open hysterotomy approach is associated with preterm delivery and adverse neonatal outcomes.

Objective

This study compared the neonatal outcomes in in utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach vs the conventional open hysterotomy approach.

Study Design

This retrospective cohort study included all consecutive patients who underwent in utero meningomyelocele closure using open hysterotomy (n=44) or a 2-port, exteriorized uterus, fetoscopic approach (n=46) at a single institution between 2012 and 2020. The 2-port, exteriorized uterus, fetoscopic closure was composed of the following 3 layers: a bovine collagen patch, a myofascial layer, and a skin. The frequency of respiratory distress syndrome and a composite of other adverse neonatal outcomes, including retinopathy of prematurity, periventricular leukomalacia, and perinatal death, were compared between the study groups. Regression analyses were performed to determine any association between the fetoscopic closure and adverse neonatal outcomes, adjusted for several confounders, including gestational age of <37 weeks at delivery.

Results

The fetoscopic closure was associated with a lower rate of respiratory distress syndrome than the open hysterotomy closure (11.5% [5 of 45] vs 29.5% [13 of 44]; P=.037). The proportion of neonates with a composite of other adverse neonatal outcomes in the fetoscopic group was half of that observed patients in the open hysterotomy group; however, this difference did not reach statistical significance (4.3% [2 of 46] vs 9.1% [4 of 44]; P=.429). Here, regression analysis has demonstrated that fetoscopic meningomyelocele closure was associated with a lower risk of respiratory distress syndrome (adjusted odds ratio, 0.23; 95% confidence interval, 0.06–0.84; P=.026) than open hysterotomy closure.

Conclusion

In utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach was associated with a lower risk of respiratory distress syndrome than the conventional open hysterotomy meningomyelocele closure.

中文翻译：

---

与开放式子宫切开术相比，两端口、外置子宫、胎儿镜下脑膜脊髓膨出闭合术对新生儿的不良后果更少

背景

使用开放式子宫切开术方法在子宫内关闭脑膜脊髓膨出与早产和不良新生儿结局相关。

客观的

本研究比较了使用 2 端口、外置子宫、胎儿镜方法与传统开放式子宫切开术方法在子宫内脑膜脊髓膨出封闭术中的新生儿结局。

学习规划

这项回顾性队列研究包括 2012 年至 2020 年在单一机构使用开放式子宫切开术（n = 44）或 2 端口、外置子宫、胎儿镜方法（n = 46）在子宫内接受脑膜脊髓膨出封闭术的所有连续患者。 2-端口、外置子宫、胎儿镜闭合由以下 3 层组成：牛胶原补片、肌筋膜层和皮肤。在研究组之间比较了呼吸窘迫综合征的频率和其他不良新生儿结局的复合，包括早产儿视网膜病变、脑室周围白质软化和围产期死亡。进行回归分析以确定胎儿镜闭合与不良新生儿结局之间的任何关联，并针对几个混杂因素进行调整，包括分娩时的胎龄 <37 周。

结果

与开放式子宫切开术关闭相比，胎儿镜关闭与呼吸窘迫综合征发生率较低相关（11.5% [5 of 45] vs 29.5% [13 of 44]；P = .037）。胎儿镜组中合并其他不良新生儿结局的新生儿比例是开腹子宫切开术组观察到的患者的一半；然而，这种差异没有达到统计学显着性（4.3% [2 of 46] vs 9.1% [4 of 44]；P = .429）。在这里，回归分析表明，胎儿镜下脑脊髓膜膨出闭合与呼吸窘迫综合征的风险较低相关（调整后的比值比，0.23；95% 置信区间，0.06-0.84；P = .026 ）比开放式子宫切开术闭合。

结论

在使用 2 端口、外置子宫的子宫脑膜膨出封闭术中，与传统的开放式子宫切开脑膜膨出封闭术相比，胎儿镜方法与呼吸窘迫综合征风险较低相关。