From the Guidelines
The recommended mode of delivery after fetoscopic in utero myelomeningocele repair is a planned cesarean section. This approach is taken to minimize the risk of uterine rupture at the fetoscopic entry sites and to avoid labor-related complications that could affect the previously repaired neural tube defect 1. The goal is to balance the risks of preterm birth, which is lower after fetoscopic surgery compared to open fetal surgery, with the benefits of delivering at a gestational age that ensures fetal lung maturity 1.
Key Considerations
- The cesarean delivery should be planned at 37-38 weeks of gestation to reduce the risks associated with prolonged pregnancy after the intrauterine intervention.
- A classical (vertical) uterine incision may be considered to avoid the fetoscopic entry sites, although the evidence does not specifically address the type of incision for fetoscopic cases.
- Antenatal corticosteroids should be administered if delivery is anticipated before 37 weeks to promote fetal lung maturity.
- The surgical team should be prepared for potential complications, including increased bleeding and possible adhesions between the fetus and uterine wall, although these risks are generally lower with fetoscopic approaches compared to open fetal surgery 1.
Post-Delivery Care
- Following delivery, the neonate should receive prompt pediatric neurosurgical evaluation to assess the repair site integrity and neurological function.
- Healthcare practitioners should also be aware of and offer support for maternal mental health risks, as pregnancies complicated by fetal anomalies can have significant psychological impacts on mothers 1.
Evidence Basis
The recommendation for a planned cesarean section after fetoscopic in utero myelomeningocele repair is based on the need to balance the risks of uterine rupture and labor complications with the benefits of fetal lung maturity, as informed by studies on outcomes after fetal surgery 1. While the specific study cited does not directly compare modes of delivery after fetoscopic repair, it highlights the importance of careful management of subsequent pregnancies after any form of fetal surgery to minimize adverse outcomes.
From the Research
Mode of Delivery after Fetoscopic In Utero Myelomeningocele Repair
The recommended mode of delivery after fetoscopic in utero myelomeningocele repair is a topic of interest, with various studies providing insights into the outcomes of different delivery methods.
- Vaginal Delivery: Some studies suggest that vaginal delivery is a viable option for women who have undergone fetoscopic repair of myelomeningocele. A study published in 2018 found that 50% of women who had fetoscopic repair delivered vaginally without complications 2.
- Cesarean Delivery: Other studies recommend cesarean delivery as a safer option. A study published in 2025 found that all trocar sites were intact at the time of cesarean deliveries, suggesting that cesarean delivery may be a safer option to prevent complications such as uterine dehiscence 3.
- Comparison of Delivery Modes: A systematic review and meta-analysis published in 2018 compared outcomes of open and fetoscopic MMC repair and found that fetoscopic repair via maternal laparotomy reduced preterm birth, but was associated with higher rates of premature rupture of membranes and preterm birth compared to open repair 4.
- Motor Function in Children: A study published in 2025 found that mode of delivery was not associated with lower-extremity motor function at age 2 years in children with myelomeningocele without in utero repair, suggesting that the mode of delivery may not have a significant impact on long-term motor function outcomes 5.
- Delivery Location: Another study published in 2020 found that patients who delivered at a referring physician's hospital had similar outcomes to those who delivered at the fetal center where their fetal intervention was performed, suggesting that delivery location may not be a significant factor in determining outcomes 6.