Benefits and complications of fetal and postnatal surgery for open spina bifida: systematic review and proportional meta‐analysis
Notice bibliographique
Résumé
OBJECTIVE: To derive pooled estimates of maternal, fetal and pediatric outcomes up to the age of 30 months in patients undergoing pre- or postnatal surgery for open spina bifida (OSB). METHODS: A systematic search was conducted in MEDLINE, PubMed (non-MEDLINE records), Embase, Web of Science, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, as well as 'gray' literature, for studies reporting on maternal, fetal and/or pediatric outcomes related to pre- or postnatal surgery for OSB. Only studies with inclusion criteria similar to those of the Management of Myelomeningocele Study were included. Study quality and risk of bias were assessed. Meta-analysis of single proportions was performed. RESULTS: No case of maternal death was reported following prenatal surgery for OSB. Common maternal complications among those who underwent prenatal surgery included preterm prelabor rupture of membranes (open classical hysterotomy, 31%; open minihysterotomy, 33%; hybrid fetoscopy, 32%; percutaneous fetoscopy, 80%) and preterm birth before 32 weeks' gestation (open classical hysterotomy, 12%; open minihysterotomy, 15%; hybrid fetoscopy, 13%; percutaneous fetoscopy, 33%). Among patients who underwent open classical hysterotomy for OSB and later became pregnant again, 4% and 9% experienced placenta accreta spectrum disorder and uterine rupture, respectively, in any subsequent pregnancy. The most common neonatal complications were respiratory distress syndrome, apnea and postnatal surgical wound revision. Perinatal and infant death rates were similar regardless of whether the surgery was performed pre- or postnatally. The rate of cerebrospinal fluid diversion surgery at 12 months after birth was lower following prenatal surgery (open classical hysterotomy, 38%; open minihysterotomy, 17%; hybrid fetoscopy, 36%; percutaneous fetoscopy, 46%) compared with postnatal surgery (81%). The proportion of toddlers walking with or without assistive devices at 30 months after birth was higher in some prenatal surgery groups (open classical hysterotomy, 72%; open minihysterotomy, 66%; percutaneous fetoscopy, 81%) compared with the postnatal repair group (57%). The rate of clean intermittent catheterization for bladder management at 30 months after birth was 39% in the open classical hysterotomy group and 41% in the percutaneous fetoscopy group, compared with 53% in the postnatal surgery group. Each surgical approach was associated with a specific constellation of procedure-related complications. CONCLUSIONS: We provide pooled estimates for maternal, fetal and pediatric outcomes for all currently used perinatal surgical approaches for OSB repair, each of which has its specific advantages and disadvantages. Our data should serve to inform clinical decision analysis to identify the best surgical approach for OSB cases. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,018 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,005 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».