Comparison of prenatal and postnatal treatments of spina bifida in Poland--a non-randomized, single-center study

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 27; no. 14; p. 1409
• Main Authors: Zamłyński, Jacek, Olejek, Anita, Koszutski, Tomasz, Ziomek, Gabriela, Horzelska, Ewa, Gajewska-Kucharek, Alicja, Maruniak-Chudek, Iwona, Herman-Sucharska, Izabela, Kluczewska, Ewa, Horak, Stanisław, Bodzek, Piotr, Zamłyński, Mateusz, Kowalik, Joanna, Horzelski, Tomasz, Bohosiewicz, Janusz
• Format: Journal Article
• Language: English
• Published: England 01.09.2014
• Subjects: Adult; Arnold-Chiari Malformation - surgery; Case-Control Studies; Child Development - physiology; Female; Fetoscopy - rehabilitation; Fetoscopy - statistics & numerical data; Gestational Age; Humans; Infant; Infant, Newborn; Meningomyelocele - surgery; Poland; Postnatal Care - methods; Postnatal Care - statistics & numerical data; Pregnancy; Prenatal Care - methods; Prenatal Care - statistics & numerical data; Spinal Dysraphism - surgery; Treatment Outcome; Ventriculoperitoneal Shunt - rehabilitation; Ventriculoperitoneal Shunt - statistics & numerical data; Young Adult; Poland; VP shunt; hindbrain herniation; hydrocephalus; myelomeningocele; operation; Chiari malformation
• ISSN: 1476-4954
• DOI: 10.3109/14767058.2013.858689

The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69-8.26) (p < 0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p < 0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16-0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00-3.48) p < 0.05) are able to walk independently. Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.