title: Maternal morbidity and reproductive outcomes related to fetal surgery.
abstract: OBJECTIVE
  The purpose of this manuscript was to examine the maternal morbidity and reproductive outcomes following maternal-fetal surgery with an emphasis on the EXIT procedure.
  
  
  METHODS
  The medical records of all women who underwent an ex-utero intrapartum treatment (EXIT) procedure or mid-gestation open maternal fetal surgery (OMFS) at our center from December 2001 to December 2011 were reviewed retrospectively. Future reproductive outcomes were obtained via telephone questionnaire.
  
  
  RESULTS
  Thirty-three women underwent maternal-fetal surgery. Twenty-six had EXIT, and seven had OMFS. The questionnaire response was 82% (27/33). Eighty-one percent (17/21) of the EXIT cohort desired future pregnancy. All who attempted (13/13) were successful. The majority (85%) conceived spontaneously and within 2.5 years on average. In the OMFS group, 40% experienced complications. One had uterine dehiscence, and another had uterine rupture requiring urgent delivery at 36 weeks. In subsequent pregnancies, 20% of OMFS cases were complicated by uterine rupture, and 8% of EXIT patients had uterine dehiscence. All had good maternal-fetal outcome.
  
  
  CONCLUSIONS
  Future reproductive capacity and complication rates in subsequent pregnancies following EXIT procedure are similar to those seen in the general population. In contrast, mid-gestation OMFS remains associated with relatively morbid complications. This evidence can help guide in counseling expectant mothers who are faced with the challenge of considering fetal surgery.
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.forename: Cecilia G
authors.initials: CG
authors.lastname: Ethun
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: Evans
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.forename: Richard T
authors.initials: RT
authors.lastname: Ivey
authors.forename: Sina
authors.initials: S
authors.lastname: Haeri
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000601:surgery*; D046128:Fetal Therapies / Q000009:adverse effects / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D020883:Hysterotomy / Q000009:adverse effects*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery*; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome; D014597:Uterine Rupture / Q000453:epidemiology* / Q000209:etiology