title: Fetal myelomeningocele repair: the post-MOMS experience at the Children's Hospital of Philadelphia.
abstract: BACKGROUND
  Fetal myelomeningocele (fMMC) repair has become accepted as a standard of care option in selected circumstances. We reviewed our outcomes for fMMC repair from referral and evaluation through surgery, delivery and neonatal discharge.
  
  
  METHODS
  All patients referred for potential fMMC repair were reviewed from January 1, 2011 through March 7, 2014. Maternal and neonatal data were collected on the 100 patients who underwent surgery.
  
  
  RESULTS
  29% of those evaluated met the criteria and underwent fMMC repair (100 cases). The average gestational age was 21.9 weeks at evaluation and 23.4 weeks at fMMC repair. Complications included membrane separation (22.9%), preterm premature rupture of membranes (32.3%) and preterm labor (37.5%). Average gestational age at delivery was 34.3 weeks and 54.2% delivered at ≥35 weeks. The perinatal loss rate was 6.1% (2 intrauterine fetal demises and 4 neonatal demises); 90.8% of women delivered at the Children's Hospital of Philadelphia and 3.4% received transfusions. With regard to the neonates, 2 received ventriculoperitoneal shunts prior to discharge; 71.1% of neonates had no evidence of hindbrain herniation on MRI. Of the 80 neonates evaluated, 55% were assigned a functional level of one or more better than the prenatal anatomic level.
  
  
  CONCLUSIONS
  In an experienced program, maternal and neonatal outcomes for patients undergoing fMMC repair are comparable to results of the MOMS trial.
authors.affiliation: Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa., USA.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Moldenhauer
authors.forename: Shelly
authors.initials: S
authors.lastname: Soni
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Rintoul
authors.forename: Susan S
authors.initials: SS
authors.lastname: Spinner
authors.forename: Nahla
authors.initials: N
authors.lastname: Khalek
authors.forename: Juan
authors.initials: J
authors.lastname: Martinez-Poyer
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
authors.forename: William H
authors.initials: WH
authors.lastname: Peranteau
authors.forename: Norma
authors.initials: N
authors.lastname: Rendon
authors.forename: Jamie
authors.initials: J
authors.lastname: Koh
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Howell
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Heuer
authors.forename: Leslie N
authors.initials: LN
authors.lastname: Sutton
authors.forename: Mark P
authors.initials: MP
authors.lastname: Johnson
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D046128:Fetal Therapies / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000601:surgery*; D015143:Philadelphia; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult