Intrauterine correction of open forms of spina bifida: comparative analysis of the results of V.I. Kulakov NMRC for OG&P of Minzdrav of Russia and the MOMS multicenter randomized trial

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Objective: This study aimed to evaluate the results of intrauterine correction of open forms of spina bifida performed at V.I. Kulakov NMRC for OG&P of Minzdrav of Russia and compare them with the results of the MOMS trial.

Materials and methods: This study included 30 patients with a confirmed diagnosis of meningomyelocele or fetal rachischisis who underwent intrauterine treatment at the center. The inclusion criteria were completion of a perinatal consultation at the center, maternal age over 18 years, singleton pregnancy, normal fetal karyotype, gestational age between 19 and 25+6 weeks, presence of Arnold–Chiari malformation type II, cervical length >20 mm, absence of fetal kyphosis >30°, and signed informed consent for surgical intervention. Comparisons were made with 78 women from the MOMS trial whose fetuses underwent intrauterine meningomyelocele repair. Statistical analysis was performed using the StatTech v 3.1.10 (Stattech LLC, Russia) and Prism v. software. 8.0.1 (GraphPad Software, USA).

Results: The most common complication of intrauterine correction for open forms of spina bifida was preterm birth. The mean gestational age at delivery was 33.3 weeks. Premature placental abruption and premature rupture of membranes were observed in 13.3% and 30% of cases, respectively. Delivery was performed via cesarean section in all cases. Correction of Arnold–Chiari II malformation was observed in 100% of the cases, and CSF shunt surgery was performed in one case for intraventricular hemorrhage. Obstetric and neurological outcomes were comparable to those of the MOMS randomized multicenter trial.

Conclusion: Timely diagnosis and careful selection of fetuses for intrauterine correction of open forms of spina bifida lead to regression of Arnold–Chiari II syndrome with subsequent improvements in neurological outcomes in children managed with an integrated multidisciplinary approach.

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作者简介

Uliana Petrova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

编辑信件的主要联系方式.
Email: u_petrova@oparina4.ru
ORCID iD: 0000-0003-0388-3104

PhD, Junior Researcher at the Innovation Development Department of the Department of Regional Cooperation and Integration, obstetrician-gynecologist at the 2nd Physiological Obstetric Department

俄罗斯联邦, Moscow

Roman Shmakov

V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of the Russian Federation

Email: mdshmakov@mail.ru
ORCID iD: 0000-0002-2206-1002

Dr. Med. Sci., Professor of the Russian Academy of Sciences, Director; Professor at the Academician G.M. Savelyeva Department of Obstetrics and Gynecology; Chief Non-staff Specialist in Obstetrics at Ministry of Health of Russia

俄罗斯联邦, Moscow

Dmitriy Zinenko

Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation

Email: zinenko1959@mail.ru
ORCID iD: 0000-0003-0477-1016

Dr. Med. Sci., Professor, Head of the Department of Neurosurgery, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery

俄罗斯联邦, Moscow

Kristina Gladkova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: k_gladkova@oparina4.ru
ORCID iD: 0000-0001-8131-4682

PhD, Senior Researcher at the Department of Fetal Medicine of the Institute of Obstetrics, Head of the 1st Obstetric Department of Pregnancy Pathology

俄罗斯联邦, Moscow

Kirill Kostyukov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: kostyukov@oparina4.ru

Dr. Med. Sci., Head of the Department of the Ultrasound and Functional Diagnosis

俄罗斯联邦, Moscow

Anastasia Nikolaeva

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: a_nikolaeva@oparina4.ru

PhD, Chief Physician

俄罗斯联邦, Moscow

Victoria Sakalo

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: v_sakalo@oparina4.ru
ORCID iD: 0000-0002-5870-4655

PhD, Junior Researcher at the Department of Obstetric and Extragenital Pathology, obstetrician-gynecologist at the 1st Obstetric Department of Pregnancy Pathology

俄罗斯联邦, Moscow

Kirill Ostrik

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: k_ostrik@oparina4.ru
ORCID iD: 0009-0005-6064-665X

anesthesiologist and intensive care physician at the Department of Anesthesiology and Intensive Care

俄罗斯联邦, Moscow

Liliyana Chugunova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: chugunova@oparina4.ru

PhD, Senior Researcher at the Department of Ultrasound and Functional Diagnosis

俄罗斯联邦, Moscow

Artem Shramko

Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation

Email: Shramko@pedklin.ru

neurosurgeon at the Neurosurgery Department, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery

俄罗斯联邦, Moscow

Yuliya Tarasenko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: yu_tarasenko@oparina4.ru
ORCID iD: 0009-0005-1945-2108

Junior Researcher at the Innovation Development Department of the Department of Regional Cooperation and Integration, obstetrician-gynecologist at the Obstetric Department

俄罗斯联邦, Moscow

Evgenia Berdichevskaya

Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation

Email: dr.maratovna@gmail.com
ORCID iD: 0000-0001-6285-1968

neurologist, neurophysiologist at the Neurosurgery Department, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery

俄罗斯联邦, Moscow

Ekaterina Balashova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: e_balashova@oparina4.ru
ORCID iD: 0000-0002-3741-0770

PhD, Leading Researcher at the Prof. A.G. Antonov Department of Anesthesiology and Intensive Care, Associate Professor at the Department of Neonatology of the Institute of Neonatology and Pediatrics

俄罗斯联邦, Moscow

Oleg Ionov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: o_ionov@oparina4.ru
ORCID iD: 0000-0002-4153-133X

Dr. Med. Sci., Head of the Prof. A.G. Antonov Department of Anesthesiology and Intensive Care; Professor at the Department of Neonatology, Faculty of Pediatrics

俄罗斯联邦, Moscow

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2. Fig. 1. Photograph of the defect before and after correction: A - intraoperative view of meningomyelocele of the fetus before intrauterine correction; B - the back of the newborn after intrauterine correction on the 1st day of life

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3. Fig. 2. Ultrasound of a fetus with meningomyelocele before and after correction. Fetus at 24 weeks of pregnancy before surgery: A - "lemon" skull shape, ventriculomegaly 11 mm; B - "banana" cerebellum configuration; C - myelomeningocele of the lumbosacral spine; G - clubfoot. Fetus at 30 weeks of pregnancy after surgery: D - width of the posterior horn of the lateral ventricle is 8 mm; E - no herniation of the cerebellar hemispheres into the foramen magnum, large cistern measuring 2 mm

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