Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Jul 2019
ReviewEndoscopic fetal surgery for neural tube defects.
Prenatal repair of open spina bifida reduces shunt rates and may improve postnatal motor and neurodevelopmental outcomes. The hysterotomy required for the open fetal surgery leaves subsequent pregnancies at risk of uterine rupture. Hysterotomy site rupture confers significant morbidity and mortality risks for both mother and fetus. ⋯ However, the percutaneous approach is being modified, and outcomes are continuing improving, now delivery reached 35 weeks. Surgical techniques for the repair of the defect are not yet standardized, and the type of defect repair may affect long-term outcomes, especially regarding neurogenic bladder and cord tethering. The role of open fetal surgery in the management of spina bifida may be restricted to selected cases in the near future.