What is the therapeutic approach to treatment of fetuses with spina bifida and MMC?
The fetal surgical treatment for spina bifida is well established. A multicenter clinical trial, the Management of Myelomeningocele Study (MoMS), showed significantly better outcomes for fetuses that had the myelomeningocele (MMC) repaired in utero compared with those that had the surgical repair post delivery. The surgical treatment involves a hysterotomy for access to the fetus, positioning the fetus to expose the spinal defect, and performing the surgical repair much as would be done for postnatal repairs. The fetus is then replaced in the uterus, fluid is added to replace amniotic fluid lost, and the uterus is closed. The mother is then carefully monitored for the development of complications including premature labor, chorioamniotic membrane separation, and infection. The fetus is then reevaluated at intervals to assess its well-being and to determine if the ventriculomegaly is normalizing.