Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this regionAJOG Global Reports at a Glance
Background: Spina bifida (SB) is a severe congenital malformation that affects approximately 150,000 infants annually, predominantly in low- and middle-income countries, leading to significant morbidity and lifelong disabilities. In Latin America, the birth prevalence of SB is notably high, often ex...
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Elsevier
2025-02-01
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| author | Jezid Miranda, PhD Miguel A. Parra-Saavedra, PhD William O. Contreras-Lopez, PhD Cristóbal Abello, MD Guido Parra, MD Juan Hernandez, MD Amanda Barrero, MD Isabela Leones, MD Adriana Nieto-Sanjuanero, MD Gerardo Sepúlveda-Gonzalez, MD Magdalena Sanz-Cortes, PhD |
| author_facet | Jezid Miranda, PhD Miguel A. Parra-Saavedra, PhD William O. Contreras-Lopez, PhD Cristóbal Abello, MD Guido Parra, MD Juan Hernandez, MD Amanda Barrero, MD Isabela Leones, MD Adriana Nieto-Sanjuanero, MD Gerardo Sepúlveda-Gonzalez, MD Magdalena Sanz-Cortes, PhD |
| author_sort | Jezid Miranda, PhD |
| collection | DOAJ |
| description | Background: Spina bifida (SB) is a severe congenital malformation that affects approximately 150,000 infants annually, predominantly in low- and middle-income countries, leading to significant morbidity and lifelong disabilities. In Latin America, the birth prevalence of SB is notably high, often exacerbated by limited healthcare resources and poor access to advanced medical care. The implementation of laparotomy-assisted fetoscopic in-utero SB repair programs in Latin America targets reducing prematurity rates and enabling vaginal births while preserving the benefits of decreased need for hydrocephalus treatment and improved mobility in children. Objective: This study evaluated the safety, efficacy, and outcomes of laparotomy-assisted fetoscopic in-utero SB repair in Latin America compared to traditional open-hysterotomy methods. Study design: This retrospective cohort study included 39 cases of laparotomy-assisted fetoscopic in-utero SB repair, with 14 cases from Mexico (2017–2021) and 25 cases from Colombia (2019–2024). These cases were compared to 78 cases from the MOMs trial and 314 from other Latin American centers using traditional open-hysterotomy methods. Statistical analyses included the Student's t-test, Kruskal-Wallis test, and Pearson's chi-square test. Results: The gestational age (GA) at the time of surgery was significantly higher in fetoscopic centers (26±1.27 weeks) compared to the MOMs trial (23.6±1.42 weeks) and traditional hysterotomy methods (25.4±1 weeks) (P<.001). Mean GA at delivery was significantly earlier in the hysterotomy-based groups than in our fetoscopic group (MOMs: 34.1 [± 3.1] vs open-repair centers in LATAM: 34 [±3002] vs Fetoscopic: 35.3 [± 3.79] weeks; P values=.14 and 0004, respectively). Moreover, and the fetoscopic repair group exhibited a significantly lower rate of spontaneous preterm births (<34 weeks) at 15.8%, compared to 46.2% in the MOMs trial group and 49% in the other Latin American centers using traditional open-hysterotomy methods (P=.004 and .001, respectively). Additionally, the fetoscopic group had higher birthweights (2618±738g) and a lower cesarean delivery rate (65.8%) compared to the other groups (P<.001). Hydrocephalus treatment requirements at 12 months were similar across all groups. No maternal deaths or other outcomes such as pulmonary edema or need for maternal transfusion were noted in the fetoscopic SB repair group. Conclusion: The laparotomy-assisted fetoscopic SB repair offers a feasible and safer alternative to traditional hysterotomy-based techniques in Latin America. This approach significantly reduces the rates of prematurity and cesarean deliveries, facilitating vaginal births and minimizing maternal morbidity. These findings support the broader adoption of fetoscopic SB repair in regions with a high prevalence of SB and suboptimal perinatal outcomes, underscoring its advantages over hysterotomy-based approaches. |
| format | Article |
| id | doaj-art-7627aa4650b042c1b83cd0fcce57240a |
| institution | Kabale University |
| issn | 2666-5778 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AJOG Global Reports |
| spelling | doaj-art-7627aa4650b042c1b83cd0fcce57240a2025-02-12T05:32:55ZengElsevierAJOG Global Reports2666-57782025-02-0151100442Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this regionAJOG Global Reports at a GlanceJezid Miranda, PhD0Miguel A. Parra-Saavedra, PhD1William O. Contreras-Lopez, PhD2Cristóbal Abello, MD3Guido Parra, MD4Juan Hernandez, MD5Amanda Barrero, MD6Isabela Leones, MD7Adriana Nieto-Sanjuanero, MD8Gerardo Sepúlveda-Gonzalez, MD9Magdalena Sanz-Cortes, PhD10Department of Obstetrics and Gynecology, Faculty of Medicine, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena, Colombia (Miranda, Leones); Department of Obstetrics and Gynecology, Centro Hospitalario Serena del Mar and Fundación Santa Fe de Bogotá, Bogotá, Colombia (Miranda); Instituto de Diagnóstico y Terapía Fetal del Caribe, Barranquilla, Colombia (Miranda, Parra-Saavedra, Barrero); Corresponding author: Jezid Miranda, MD, PhD.Instituto de Diagnóstico y Terapía Fetal del Caribe, Barranquilla, Colombia (Miranda, Parra-Saavedra, Barrero); Department of Obstetrics and Gynecology, Universidad Simon Bolivar, Barranquilla, Colombia (Parra-Saavedra)International Neuromodulation Center-NEMOD, Clinica FOSCAL International, Floridablanca, Colombia (Contreras-Lopez); Universidad Autonoma de Bucaramanga, Facultad de Medicina, UNAB, Colombia (Contreras-Lopez)Departamento de Cirugía Pediátrica y neonatal mínimamente invasiva, Universidad del Norte, Barranquilla, Colombia (Abello); DrAbelloIPs Centro de Cirugia Pediatrica, Neonatal y Fetal alta complejidad y minima invasion, Barranquilla, Colombia (Abello)CEDIFETAL, Centro Médico CEDIUL, Barranquilla, Colombia (Parra)Sociedad Colombiana de Anestesiología, departamento de Anestesiología, Clinica General del Norte, Barranquilla, Colombia (Hernandez)Instituto de Diagnóstico y Terapía Fetal del Caribe, Barranquilla, Colombia (Miranda, Parra-Saavedra, Barrero)Department of Obstetrics and Gynecology, Faculty of Medicine, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena, Colombia (Miranda, Leones)Departamento de Pediatría, Hospital Universitario “Dr. José Eleuterio González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico (Nieto-Sanjuanero)Instituto de Salud Fetal, Hospital Materno infantil de Monterrey, Monterrey, Nuevo Leon, Mexico (Sepúlveda-Gonzalez); Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México (Sepúlveda-Gonzalez)Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Division of Fetal Surgery and Intervention, Houston, TX (Sanz-Cortes)Background: Spina bifida (SB) is a severe congenital malformation that affects approximately 150,000 infants annually, predominantly in low- and middle-income countries, leading to significant morbidity and lifelong disabilities. In Latin America, the birth prevalence of SB is notably high, often exacerbated by limited healthcare resources and poor access to advanced medical care. The implementation of laparotomy-assisted fetoscopic in-utero SB repair programs in Latin America targets reducing prematurity rates and enabling vaginal births while preserving the benefits of decreased need for hydrocephalus treatment and improved mobility in children. Objective: This study evaluated the safety, efficacy, and outcomes of laparotomy-assisted fetoscopic in-utero SB repair in Latin America compared to traditional open-hysterotomy methods. Study design: This retrospective cohort study included 39 cases of laparotomy-assisted fetoscopic in-utero SB repair, with 14 cases from Mexico (2017–2021) and 25 cases from Colombia (2019–2024). These cases were compared to 78 cases from the MOMs trial and 314 from other Latin American centers using traditional open-hysterotomy methods. Statistical analyses included the Student's t-test, Kruskal-Wallis test, and Pearson's chi-square test. Results: The gestational age (GA) at the time of surgery was significantly higher in fetoscopic centers (26±1.27 weeks) compared to the MOMs trial (23.6±1.42 weeks) and traditional hysterotomy methods (25.4±1 weeks) (P<.001). Mean GA at delivery was significantly earlier in the hysterotomy-based groups than in our fetoscopic group (MOMs: 34.1 [± 3.1] vs open-repair centers in LATAM: 34 [±3002] vs Fetoscopic: 35.3 [± 3.79] weeks; P values=.14 and 0004, respectively). Moreover, and the fetoscopic repair group exhibited a significantly lower rate of spontaneous preterm births (<34 weeks) at 15.8%, compared to 46.2% in the MOMs trial group and 49% in the other Latin American centers using traditional open-hysterotomy methods (P=.004 and .001, respectively). Additionally, the fetoscopic group had higher birthweights (2618±738g) and a lower cesarean delivery rate (65.8%) compared to the other groups (P<.001). Hydrocephalus treatment requirements at 12 months were similar across all groups. No maternal deaths or other outcomes such as pulmonary edema or need for maternal transfusion were noted in the fetoscopic SB repair group. Conclusion: The laparotomy-assisted fetoscopic SB repair offers a feasible and safer alternative to traditional hysterotomy-based techniques in Latin America. This approach significantly reduces the rates of prematurity and cesarean deliveries, facilitating vaginal births and minimizing maternal morbidity. These findings support the broader adoption of fetoscopic SB repair in regions with a high prevalence of SB and suboptimal perinatal outcomes, underscoring its advantages over hysterotomy-based approaches.http://www.sciencedirect.com/science/article/pii/S2666577825000036congenital malformationsfetal neural tube defectsfetal surgeryminimally invasive surgerymyelomeningocelepediatric neurosurgery |
| spellingShingle | Jezid Miranda, PhD Miguel A. Parra-Saavedra, PhD William O. Contreras-Lopez, PhD Cristóbal Abello, MD Guido Parra, MD Juan Hernandez, MD Amanda Barrero, MD Isabela Leones, MD Adriana Nieto-Sanjuanero, MD Gerardo Sepúlveda-Gonzalez, MD Magdalena Sanz-Cortes, PhD Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this regionAJOG Global Reports at a Glance AJOG Global Reports congenital malformations fetal neural tube defects fetal surgery minimally invasive surgery myelomeningocele pediatric neurosurgery |
| title | Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this regionAJOG Global Reports at a Glance |
| title_full | Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this regionAJOG Global Reports at a Glance |
| title_fullStr | Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this regionAJOG Global Reports at a Glance |
| title_full_unstemmed | Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this regionAJOG Global Reports at a Glance |
| title_short | Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this regionAJOG Global Reports at a Glance |
| title_sort | implementation of in utero laparotomy assisted fetoscopic spina bifida repair in two centers in latin america rationale for this approach in this regionajog global reports at a glance |
| topic | congenital malformations fetal neural tube defects fetal surgery minimally invasive surgery myelomeningocele pediatric neurosurgery |
| url | http://www.sciencedirect.com/science/article/pii/S2666577825000036 |
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