title: Prenatal diagnosis and patient preferences in patients with neural tube defects around the advent of fetal surgery in Belgium and Holland.
abstract: BACKGROUND
  We review the characteristics and prenatal choices of patients recently evaluated for neural tube defects (NTD) at two tertiary units. The prenatal diagnosis of NTD allows parents to consider all prenatal options. In selected cases of spina bifida aperta this also includes fetal surgery, which we started offering after combined 'in-house' and 'exported' training.
  
  
  METHODS
  This is a retrospective review of prospectively collected data on NTD diagnosed over the last 8 years and recent fetal surgery referrals.
  
  
  RESULTS
  A total of 167 patients were referred for assessment at a median of 19 weeks. Cranial lesions were diagnosed significantly earlier than spinal lesions. Of the open spinal lesions, 77% were isolated. Of these, 22% were managed expectantly and 1 (1%) had fetal surgery. There was no correlation between parental decisions on prenatal management with disease-specific severity markers. We had 14 fetal surgery referrals, all but 1 from beyond our typical referral area; 6 of the assessed patients were operated on, 4 were expectantly managed and 4 requested termination of pregnancy (TOP). These pregnancy outcomes were in the expected range.
  
  
  CONCLUSIONS
  Open spina bifida is mainly diagnosed in the second trimester and 76% of subjects request TOP, irrespective of the severity indicators. The number of local patients considering fetal surgery is low.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Céline
authors.initials: C
authors.lastname: Ovaere
authors.forename: Alex
authors.initials: A
authors.lastname: Eggink
authors.forename: Jute
authors.initials: J
authors.lastname: Richter
authors.forename: Titia E
authors.initials: TE
authors.lastname: Cohen-Overbeek
authors.forename: Frank
authors.initials: F
authors.lastname: Van Calenbergh
authors.forename: Katrien
authors.initials: K
authors.lastname: Jansen
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
authors.forename: Roland
authors.initials: R
authors.lastname: Devlieger
authors.forename: Luc
authors.initials: L
authors.lastname: De Catte
authors.forename: Jan A
authors.initials: JA
authors.lastname: Deprest
mesh_terms: D000293:Adolescent; D000328:Adult; D001530:Belgium; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D046128:Fetal Therapies / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands; D009436:Neural Tube Defects / Q000000981:diagnostic imaging / Q000601:surgery*; D057240:Patient Preference / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D055815:Young Adult