Obstetric outcomes after fetal intervention – a single-center descriptive review

Abstract

Background

Advancements in fetal interventions have enabled in utero management of several fetal congenital anomalies and conditions; these are accomplished via ultrasound-guided, fetoscopic or open techniques. Understanding the risk of preterm labor associated with each technique is critical for patient counseling and choice of intervention; however, data on obstetrical outcomes associated with each type of intervention remains limited.

Objective

To provide descriptive information on the risk of preterm birth following fetal intervention, based on underlying disease and procedure performed.

Study design

This is a retrospective cohort study of patients who underwent fetal intervention at our institution between 1 October 2016 and 31 December 2019. Interventions were stratified into three groups- ultrasound-guided, fetoscopic and open procedures. Procedures included fetoscopic laser ablation (FLA) for twin-to-twin transfusion syndrome (TTTS), fetoscopic endotracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH), vesicoamniotic shunt (VAS) for lower urinary tract obstruction (LUTO), fetal cystoscopy for LUTO, and open and fetoscopic myelomeningocele repair. The primary outcomes were gestational age at delivery and frequency of premature rupture of the membranes.

Results

Sixty-eight patients were included; 20 (29.4%) underwent ultrasound- guided procedures, 37 (54.4%) underwent fetoscopy, and 11 (16.2%) open in utero intervention. The diagnoses and type of intervention within each group were different. The mean gestational age (GA) ± standard deviation (SD) at intervention for ultrasound- guided, fetoscopic, open procedures were 24.1 ± 4.4 weeks, 22.8 ± 3.7 weeks, and 25.0 ± 0.9 weeks, respectively. The mean GA ± SD at delivery were 31.9 ± 4.9 weeks, 31.6 ± 4.6 weeks, and 32.6 ± 5.5 weeks, respectively. The mean interval from time of intervention to delivery were 54 ± 39, 62 ± 37 and 55 ± 36 days, respectively (p = 0.82); and the risk of PPROM was 26.3%, 21.6% and 27.3%, respectively. The mean GA at delivery and the frequency of PPROM were different for each specific disease that was treated.

Conclusion

The risk of preterm birth and PPROM following fetal intervention with different procedures, categorized under ultrasound- guided, fetoscopic and open fetal interventions at our institution were similar amongst the three groups, but they were different depending on the diagnosis of the treated anomaly.

Keywords:

• Fetal surgery/intervention
• congenital anomalies
• preterm delivery
• twin to twin transfusion syndrome
• myelomeningocele
• congenital diaphragmatic hernia
• lower urinary tract obstruction

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors contribution

Dr. Kavita Narang, MD contributed to conceptualization, data curation, methodology, investigation, and, writing, reviewing and editing of manuscript.

Dr. Eniola Ibirogba, MBBS contributed to investigation, data curation and reviewing and editing of manuscript

Dr. Haleh Sangi-Haghpeykar,PhD contributed to Formal analysis and writing, reviewing and editing the manuscript.

Dr. Rodrigo Ruano, MD contributed to conceptualization, methodology, validation, Review and editing of manuscript and supervision.