(146) Maternal and Neonatal Outcomes after Fetoscopic Prenatal versus Postnatal Repair of Open Neural Tube Defects

Prenatal repair of open neural tube defects (ONTDs) via hysterotomy offers significant fetal benefits but is highly invasive and poses maternal risks, influencing the choice between prenatal and postnatal repair. Fetoscopic repair is a promising alternative to open prenatal surgery, aiming to provide similar fetal neurological benefits with reduced maternal morbidity and the potential for vaginal delivery (VD). We evaluated maternal and neonatal outcomes for fetoscopic vs. postnatal repair.


Study Design:

This is a retrospective cohort study of fetal ONTDs referred to a single fetal center from 2020 to 2024. Demographic, surgical, and outcome data were collected and compared between patients who chose fetoscopic prenatal repair versus postnatal repair. Primary outcomes included VD rate and need for CSF diversion in the first year. Secondary outcomes included postpartum blood loss, hospital encounters, surgery length for cesarean delivery (CD), severe maternal morbidity (SMM), preterm delivery rates, and NICU length of stay (LOS).


Results:

During the study period fetoscopic surgery was performed in 12 patients and 29 opted for postnatal repair. Maternal and fetal characteristics were similar, with the exception of a higher rate of myeloschisis in the fetoscopic repair group (Table 1). Vaginal delivery (VD) rates were similar between groups (66.7% for fetoscopic repair vs. 35.7% for postnatal repair, p=.09). For those who ultimately underwent cesarean delivery (CD), the length of procedure was significantly longer in patients who underwent fetoscopic prenatal repair (p=0.02), however there was no difference in other measures of maternal morbidity. With regards to neonatal outcomes, there was a lower rate of CSF diversion in the prenatal repair group (40.0% vs. 78.3%, p=0.03). These patients also delivered at an earlier gestational age (35.7 vs. 39.0 weeks, p=0.001), however NICU LOS was similar between groups (Table 2).


Conclusion:

Fetoscopic repair of ONTDs is associated with improved fetal neurologic outcomes compared to postnatal repair and high rates of vaginal delivery.