Context Intrauterine closure of exposed spinal cord tissue prevents seconda
ry neurologic injury in animals with a surgically created spinal defect; ho
wever, whether in utero repair of myelomeningocele improves neurologic outc
ome in infants with spina bifida is not known.
Objective To determine whether intrauterine repair of myelomeningocele impr
oves patient outcomes compared with standard care.
Design Single-institution, nonrandomized observational study conducted betw
een January 1990 and February 1999.
Setting Tertiary care medical center.
Participants A sample of 29 study patients with isolated fetal myelomeningo
cele referred for intrauterine repair that was performed between 24 and 30
gestational weeks and 23 controls matched to cases for diagnosis, level of
lesion, practice parameters, and calendar time. All infants were followed u
p for a minimum of 6 months after delivery.
Main Outcome Measures Requirement for ventriculoperitoneal shunt placement,
obstetrical complications, gestational age at delivery, and birth weight f
or study vs control subjects.
Results The requirement for ventriculoperitoneal shunt placement for decomp
ression of hydrocephalus was significantly decreased among study infants (5
9% vs 91%, P =.01). The median age at shunt placement was also older among
study infants (50 vs 5 days; P =.006). This may be explained by the reduced
incidence of hindbrain herniation among study infants (38% vs 95%; P<.001)
, Following hysterotomy, study patients had an increased risk of oligohydra
mnios (48% vs 4%; P =.001) and admission to the hospital for preterm uterin
e contractions (50% vs 9%; P =.002). The estimated gestational age at deliv
ery was earlier for study patients (33.2 vs 37.0 weeks; P<.001), and the bi
rth weight of study neonates was less (2171 vs 3075 g; P<.001).
Conclusions Our study suggests that intrauterine repair of myelomeningocele
decreases the incidence of hindbrain herniation and shunt-dependent hydroc
ephalus in infants with spina bifida, but increases the incidence of premat
ure delivery.