title: Comparison of prenatal and postnatal treatments of spina bifida in Poland--a non-randomized, single-center study.
abstract: OBJECTIVE
  The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally.
  
  
  METHODS
  The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study.
  
  
  RESULTS
  High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69-8.26) (p < 0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p < 0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16-0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00-3.48) p < 0.05) are able to walk independently.
  
  
  CONCLUSIONS
  Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.
authors.affiliation: Department of Gynecology, Obstetrics and Gynecologic Oncology in Bytom, Medical University of Silesia , Bytom , Poland .
authors.forename: Jacek
authors.initials: J
authors.lastname: Zamłyński
authors.forename: Anita
authors.initials: A
authors.lastname: Olejek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Koszutski
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ziomek
authors.forename: Ewa
authors.initials: E
authors.lastname: Horzelska
authors.forename: Alicja
authors.initials: A
authors.lastname: Gajewska-Kucharek
authors.forename: Iwona
authors.initials: I
authors.lastname: Maruniak-Chudek
authors.forename: Izabela
authors.initials: I
authors.lastname: Herman-Sucharska
authors.forename: Ewa
authors.initials: E
authors.lastname: Kluczewska
authors.forename: Stanisław
authors.initials: S
authors.lastname: Horak
authors.forename: Piotr
authors.initials: P
authors.lastname: Bodzek
authors.forename: Mateusz
authors.initials: M
authors.lastname: Zamłyński
authors.forename: Joanna
authors.initials: J
authors.lastname: Kowalik
authors.forename: Tomasz
authors.initials: T
authors.lastname: Horzelski
authors.forename: Janusz
authors.initials: J
authors.lastname: Bohosiewicz
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D016022:Case-Control Studies; D002657:Child Development / Q000502:physiology; D005260:Female; D005332:Fetoscopy / Q000534:rehabilitation / Q000706:statistics & numerical data; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000601:surgery*; D011044:Poland; D011181:Postnatal Care / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data; D016135:Spinal Dysraphism / Q000601:surgery*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000534:rehabilitation / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Chiari malformation; VP shunt; hindbrain herniation; hydrocephalus; myelomeningocele; operation