Prenatal repair of myelomeningocele more beneficial than postnatal

January 01, 0001

Prenatal repair of myelomeningocele more beneficial than postnatal

These US investigators compared outcomes of in utero repair of myelomeningocele with standard postnatal repair. They randomly assigned eligible women to undergo either prenatal surgery before 26 weeks of gestation or standard postnatal repair. One primary outcome was a composite of fetal or neonatal death or the need for placement of a cerebrospinal fluid shunt by the age of 12 months. Another primary outcome at 30 months was a composite of mental development and motor function.

They found: "The trial was stopped for efficacy of prenatal surgery after the recruitment of 183 of a planned 200 patients. This report is based on results in 158 patients whose children were evaluated at 12 months. The first primary outcome occurred in 68% of the infants in the prenatal-surgery group and in 98% of those in the postnatal-surgery group (relative risk, 0.70). Actual rates of shunt placement were 40% in the prenatal-surgery group and 82% in the postnatal-surgery group (relative risk, 0.48). Prenatal surgery also resulted in improvement in the composite score for mental development and motor function at 30 months and in improvement in several secondary outcomes, including hindbrain herniation by 12 months and ambulation by 30 months. However, prenatal surgery was associated with an increased risk of preterm delivery and uterine dehiscence at delivery."

The authors concluded: "Prenatal surgery for myelomeningocele reduced the need for shunting and improved motor outcomes at 30 months but was associated with maternal and fetal risks."

Prenatal surgery to repair myelomeningocele will likely become the preferred approach based on this study.

For the full abstract, click here.

N Engl J Med online 9 February 2011
© 2011 to the Massachusetts Medical Society
A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele. N. Scott Adzick, Elizabeth A. Thom, Catherine Y. Spong, et al. Correspondence to Dr. Adzick: [email protected]

Category: N. Neurological, W. Pregnancy, Childbirth, Family Planning. W. Keywords: myelomeningocele, surgical repair, death, cerebrospinal fluid shunt, mental development, motor function, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 February 2011

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