Surgical technique affects gestational age at birth in prenatal spina bifida repair.

Review paper published in American Journal of Obstetrics and Gynecology Volume 232 Issue 6 takes a close look at how the timing of delivery varies based on different surgical techniques used for prenatal repair of open spina bifida.

It compares open repair, mini-hysterotomy, laparotomy-assisted fetoscopic repair, and percutaneous fetoscopic repair
Analyzes gestational age at birth along with rates of preterm premature rupture of membranes and vaginal birth
Finds some differences in outcomes, particularly a possible advantage with the laparotomy-assisted approach for reducing preterm births

Prenatal repair of open spina bifida has become well-established, and this study compares the gestational age at delivery following various surgical techniques .
A meta-analysis of 37 studies (2010-2023) was conducted, including open repair, mini-hysterotomy, laparotomy-assisted fetoscopic repair, and percutaneous fetoscopic repair .
The analysis suggests that the mean gestational age at birth may differ among the surgical techniques, with a potential advantage for laparotomy-assisted approach

Neural tube defects (NTDs), with spina bifida being the most common, affect approximately 3000 pregnancies annually in the United States .
There are four main surgical techniques for prenatal repair of NTDs: open hysterotomy, mini-hysterotomy, laparotomy-assisted fetoscopy, and percutaneous technique .
This study provides a systematic review and meta-analysis of these four surgical approaches, comparing the gestational age at delivery to help identify optimal prenatal treatment strategies

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines .
The meta-analysis included randomized control trials and observational studies from 2010 to 2023 that detailed maternal/fetal outcomes of intrauterine repair of open spina bifida .
Data was extracted independently by two authors using uniform data extraction sheets, and conflicts were resolved by a third author.

The meta-analysis reviewed 2333 prenatal repair procedures from 37 studies across 14 countries (2010-2024), including open repair (65.7%), mini-hysterotomy (14.4%), laparotomy-assisted fetoscopic repair (5.4%), and percutaneous fetoscopic repair (14.6%) .
The mean gestational age at birth was 34+1, 34+2, 35+3, and 32+3 weeks for open repair, mini-hysterotomy, laparotomy-assisted fetoscopy, and percutaneous fetoscopy, respectively, with no statistically significant differences among subgroups (P=0.26) .
75% of 1379 deliveries occurred preterm at <37 weeks, with significant differences between subgroups (P<.01)

The study aimed to systematically review outcomes of prenatal repair of open spina bifida, comparing different surgical approaches to inform patient counseling regarding risks and benefits .
Bayesian analysis indicated gestational age at birth varied significantly between surgical approaches, with laparotomy-assisted repair achieving the highest mean gestational age .
Meta-regression revealed the impact of surgical technique and year of study publication on gestational age at birth