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Recent developments in fetal therapy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
As an unanticipated side effect, the MOMS trial apparently slowed down the clinical development of minimally invasive techniques to perform this operation in the United States (3). Nevertheless, endoscopic coverage of the defect is currently explored by several teams, experimentally and also clinically (64,65).
Fetal surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Emily A. Partridge, Alan W. Flake
The MOMS trial was powered to recruit 200 participants, but was halted after randomization of 183 patients when a planned interim analysis demonstrated clear benefit for prenatal surgery. The fetal surgery group showed significant reduction in rates of shunt placement at 1 year (40% versus 82%) and improvement in neuromotor function by 30 months of age, including the ability to walk without orthotics (42% versus 21%). The degree and presence of hindbrain herniation was also improved, with no hindbrain herniation in 36% of fetal surgery patients and 4% of postnatal surgery patients, and severe hindbrain herniation in 6% of fetal surgery patients and 22% of postnatal surgery patients. The benefits of fetal repair outweighed the complications related to prematurity and the maternal morbidity seen in the study.
Fetal malformations detected with magnetic resonance imaging in the diabetic mother
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Spina bifida (the so-called meningomyelocele) is a common fetal malformation of the CNS. It can cause a significant neurological handicap. In utero surgical restoration of meningomyelocele has been increasingly offered after the result of a randomized trial of prenatal versus postnatal repair of myelomeningocele (MoMs trial) suggested its benefit of decrease postnatal shunt placement and improved motor outcomes.24 Fetal MRI has been advocated in this trial to detect hindbrain herniation, as shown in Figure 42.14. This is used not only for prognostic purposes but also to monitor the possibility of reversal of hindbrain herniation in cases that opted for in utero repair. Comparison of advantages and disadvantages between ultrasound and MRI in imaging of fetal NTD are summarized in Table 42.2.
Experience and Ethics at the “Cutting Edge”: Lessons From Maternal–Fetal Surgery for Uterine Transplantation
Published in The American Journal of Bioethics, 2018
Virginia L. Bartlett, Mark J. Bliton, Stuart G. Finder
The challenging work of finding out what matters to these women considering this set of UT procedures so as to better provide support and care requires paying careful and explicit attention to their experiences—and again, the experiences of women and clinicians involved with MFSSB offers approaches to doing so that serve both participants and clinicians. For example, as MFSSB moved from an elective, experimental procedure to a NICHD randomized controlled clinical trial—the Management of Myelomeningocele Study (MOMS Trial)—Bliton and Churchill invited and then published essays from women and their partners 3–5 years after they underwent the procedure in order to “bring to light the facets of the experience that are likely to be overlooked in qualitative methods, scientific or legal analysis or even in ethical analysis as it is typically concerned” (Churchill and Bliton 2005). Given the overlapping themes between MFSSB and UT, these essays, in a “Parental Voices” special issue of Clinical Obstetrics and Gynecology, can offer insights to clinicians and ethicists currently grappling with informed consent and the protection of both potential living donors and potential recipients in UT.
A study to assess knowledge and acceptability of foetal surgery for spina bifida amongst healthcare professionals in the UK
Published in Journal of Obstetrics and Gynaecology, 2020
Adalina Sacco, Shahanaz Ahmed, Jan Deprest, Anna L. David
Knowledge about foetal surgery was rated highest in MFM clinicians, with most other groups rating their knowledge as ‘limited’ (Figure 2). Most respondents (72.4%) had no experience performing or counselling about foetal surgery. Familiarity with the MOMS trial was highest amongst MFM clinicians and paediatric neurosurgeons and the ‘two-hit’ hypothesis was generally well-known. Around 70% of respondents agreed with the concept that foetal surgery improved the outcome in selected cases, suggesting that this was generally acceptable as a treatment option; although, this was lower in the group of paediatric neurosurgeons (41%).
Neuropathology Evaluation of in Utero Correction of Myelomeningocele and Complications of Late-Onset GBS Infection
Published in Fetal and Pediatric Pathology, 2023
Sarah Edminster, Tai-Wei Wu, Alexander Van Speybroeck, Jason Chu, Denise A. Lapa, Ramen H. Chmait, Linda J. Szymanski
MMC, the most severe form of spina bifida, causes significant morbidity and mortality if left unrepaired. Over the years, significant progress has been made to prenatally correct this defect to ameliorate the risks of this condition. The Management of Myelomeningocele Study (MOMS) trial showed that prenatal repair of MMC reduced the need for ventriculoperitoneal shunting at 12 months and improved motor outcomes at 30 months when compared to postnatal surgical intervention [5].