(1042) Maternal and Neonatal Outcomes Following Fetoscopic versus Open Prenatal Surgery for Open Neural Tube Defects

Fetoscopic repair of open neural tube defects (ONTDs) is a promising alternative to open prenatal surgery via hysterotomy that may confer similar fetal benefits while allowing for vaginal delivery (VD) in the index and subsequent pregnancies. We sought to evaluate maternal and neonatal outcomes following fetoscopic versus open prenatal surgery for ONTDs.


Study Design:

This was a retrospective cohort study of all patients who underwent prenatal ONTD repair at a single fetal center from 2020 to 2024. Fetoscopic repair with a multi-layer closure identical to those done open via hysterotomy was offered to all patients starting in 2023.  Demographic information, ultrasound findings, and maternal and neonatal outcomes were collected and compared for open and fetoscopic cases. Primary outcomes were rate of severe maternal morbidity (SMM) as defined by the CDC and need for CSF diversion in the first year of life. Secondary outcomes were PPROM, VD rate, length of surgery for patients undergoing cesarean delivery (CD), postpartum length of stay (LOS), live birth, preterm birth, postnatal imaging findings and NICU LOS.


Results:

Of 36 prenatal repairs, open surgery was performed in 24 (66.7%) and fetoscopic surgery was performed in 12 (33.3%). Pre-surgical characteristics were similar between groups, with the exception of a higher rate of myeloschisis in the fetoscopic repair group (Table 1). With regards to maternal outcomes, fetoscopic repair was associated with lower rate of SMM (0.0% vs. 33.3%, p=0.03), lower delivery EBL (200mL vs. 800mL, p< 0.001), and a shorter postpartum stay (2.2 days vs. 3.7 days (p< 0.001) which is likely related to a higher rate of vaginal birth in the fetoscopic repair group (66.7% vs. 0.0%, p< 0.001). Neonatal outcomes including preterm birth, NICU length of stay, postnatal hydrocephalus, and need for CSF diversion were not statistically different.


Conclusion:

Fetoscopic prenatal repair of ONTD is associated with lower rates of SMM, lower EBL at delivery, and shorter postpartum stay when compared to open repair, but appears to confer similar fetal neurological benefit.