Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Fetus

Poster Session 2

(550) Fetoscopic Spina Bifida(fSB) repair with Human Umbilical Cord(HUC) Compared with Open In-Utero SB Repair (oSB)

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Ramesha Papanna, MD, MPH

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

    • Coauthor(s)

  • SF

    Stephen A. Fletcher, DO

    Neurosurgery, Pediatric Neurosurgery
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • LM

    Lovepreet Mann, MBBS (she/her/hers)

    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Jeannine Garnett, PhD (she/her/hers)

    Program Manager, Research - Ob/Gyn Maternal Fetal Medicine
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Neha Agarwal, MBBS, MD

    Post doctoral Research Fellow
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • AS

    Ashley Salazar, DNP

    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Sami Backley, MD

    Clinical Fellow PGY 8
    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

  • SP

    Shreya Pandiri, BS

    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Eric P. Bergh, MD

    Assistant Professor
    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

  • MA

    Mary Austin, MD

    Pediatric Surgeon
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • BM

    Brandon Miller, MD

    Assistant Professor, Division Of Pediatric Neurosurgery
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • JR

    Jerrie Refuerzo, MD

    Associate Professor
    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

  • Jimmy Espinoza, MD, MSc (he/him/his)

    Professor
    McGovern Medical School at the University of Texas Health Science Center Houston, The Fetal Center- Children’s Memorial Hermann Hospital
    Houston, TX, United States

  • Anthony Johnson, DO

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • RJ

    Ranu Jain, MD

    Division of pediatric anesthesiology, Department of Anesthesiology, Critical Care and Pain Medicine
    Houston, TX, United States

  • Kuojen Tsao, MD

    Chief of Pediatric Surgery
    McGovern Medical School at Houston, UTHealth Houston
    Houston, TX, United States

Objective:

After successfully testing fSB repair with HUC as a meningeal patch for small myelomeningocele cases, we expanded to include all spina bifida defects, aiming to compare fSB with oSB repair.

Study Design:

Under a single-arm interventional Food and Drug Administration investigational device exemption and Institutional Review Board approved protocol, we offered fSB-HUC to patients who were candidates for oSB with a fetal spina bifida. The surgical approach was laparotomy-assisted via 3 ports (5 mm, 16 Fr and 9 Fr), with anchored fetal membranes, and it was performed under heated-humified carbon dioxide at a gestational age of 24–25 6/7 weeks. Following placode dissection, the HUC patch was sutured circumferentially using a 4-O Stratafix suture, followed by skin closure with or without HUC patch. Three independent pediatric neurosurgeons assessed the primary outcome of successful closure by image review. Outcomes were compared to our prospective cohort of oSB repair patients from the same center.

Results:

Overall, 50/53 consented to participate in the study, 49 underwent procedure (1 case excluded due to hypertonic uterus).  There were no conversions to open repair. The primary outcome was successful in all 49 fSB-HUC repairs. Significant difference in variables in gestational at evaluation and myeloschis was higher in fSB repair(Table). The total operative time and fetal surgical time was 90 minutes longer in the fSB-HUC repair group compared to oSB repair. There was no difference in preterm premature rupture of membranes and gestational age at delivery. Fifty-eight percent of fSB-HUC repair cases delivered vaginally.  At birth, there was no leakage of cerebrospinal fluid in the fSB-HUC group compared to 5% in the oSB group, but it did not reach statistical difference.

Conclusion:

Fetoscopic myelomeningocele repair using the HUC as a meningeal patch is feasible, having comparable neonatal short-term outcomes when compared to open in-utero repair. Vaginal delivery was possible in the majority of fetoscopically repaired patients.