title: Percutaneous minimal-access fetoscopic surgery for spina bifida aperta. Part II: maternal management and outcome.
abstract: OBJECTIVE
  To assess maternal morbidity and outcome in women undergoing minimal-access fetoscopic surgery for spina bifida aperta.
  
  
  METHODS
  This was a retrospective study of 51 women undergoing minimal-access fetoscopic surgery to improve postnatal neurological outcome of spina bifida aperta, at a mean gestational age of 24 weeks, at our center between July 2010 and June 2013. We analyzed various perioperative complications of surgery, namely: maternal and fetal death, need for maternal blood transfusion, placental abruption, pulmonary edema, spontaneous labor, oligohydramnios, chorioamnionitis, chorioamniotic membrane separation, duration of hospitalization, amniotic fluid leakage, gestational age at delivery and status of hysterotomy site.
  
  
  RESULTS
  In none of the 51 women was there maternal demise, spontaneous labor, placental abruption or a need for maternal blood transfusion in the perioperative period. Chorioamniotic membrane separation occurred in one patient, mild pulmonary edema occurred in one and oligohydramnios occurred in seven. All fetuses survived surgery, but there was one very early preterm delivery 1 week after the procedure and this neonate died immediately, from early postoperative chorioamnionitis. Amniotic fluid leakage occurred in 43 patients, at a mean gestational age of 29.7 (range, 22.6-37.3) weeks; two of these patients developed chorioamnionitis. Duration of maternal hospitalization after surgery was 7.2 (range, 4-12) days. Mean gestational age at delivery was 33 (range, 24.6-38.1) weeks. All abdominal and uterine trocar insertion sites healed well.
  
  
  CONCLUSIONS
  Minimal-access fetoscopic surgery for spina bifida aperta is apparently safe for most maternal patients. Despite the common occurrence of amniotic leakage, the majority of women deliver beyond 32 weeks of gestation.
authors.affiliation: Department of Obstetrics & Gynecology, University of Giessen-Marburg, Giessen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Degenhardt
authors.forename: R
authors.initials: R
authors.lastname: Schürg
authors.forename: A
authors.initials: A
authors.lastname: Winarno
authors.forename: F
authors.initials: F
authors.lastname: Oehmke
authors.forename: A
authors.initials: A
authors.lastname: Khaleeva
authors.forename: A
authors.initials: A
authors.lastname: Kawecki
authors.forename: C
authors.initials: C
authors.lastname: Enzensberger
authors.forename: H-R
authors.initials: HR
authors.lastname: Tinneberg
authors.forename: D
authors.initials: D
authors.lastname: Faas
authors.forename: H
authors.initials: H
authors.lastname: Ehrhardt
authors.forename: R
authors.initials: R
authors.lastname: Axt-Fliedner
authors.forename: T
authors.initials: T
authors.lastname: Kohl
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods; D002985:Clinical Protocols; D003376:Counseling; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007902:Length of Stay; D019990:Perioperative Care / Q000379:methods; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D012017:Referral and Consultation; D012189:Retrospective Studies; D016137:Spina Bifida Cystica / Q000601:surgery*; D055815:Young Adult
keywords: fetal surgery; fetoscopy; fetus; outcome; spina bifida aperta