Maternal-Fetal Surgery for Myelomeningocele
Maternal-Fetal Surgery for Myelomeningocele
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DOI：
10.1097/aog.0000000000002303
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发表时间：
2017-09-01
影响因子：
7.2
通讯作者：
Kuller, Jeffrey A.
中科院分区：
文献类型：
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作者：
Miller, Russell S.;Kuller, Jeffrey A.
脊髓脊膜膨出是脊柱裂的一种严重形式，在美国大约每3000个活产儿中就有1个发生。残疾的程度一般与脊髓脊膜膨出缺损的程度有关，病变的高度越高，缺损程度一般越大。髓系脑膜膨出的开放式母胎手术是妇女及其受影响胎儿的主要手术。虽然已证实对胎儿和儿童有潜在的益处，但在妊娠期、术后、妊娠期间和随后的妊娠中，可能会出现显著的母体影响和并发症。妊娠合并胎儿脊髓脊膜膨出且符合既定宫内修复标准的妇女，应以非指示方式告知所有治疗方案，包括开放式母胎手术的可能性。髓系脑膜膨出修复的母胎手术应只提供给精心挑选的患者，并在适当的人员和资源水平的设施。
Myelomeningocele, a severe form of spina bifida, occurs in approximately 1 in 3,000 live births in the United States. The extent of disability is generally related to the level of the myelomeningocele defect, with a higher upper level of lesion generally corresponding to greater deficits. Open maternal-fetal surgery for myelomeningocele repair is a major procedure for the woman and her affected fetus. Although there is demonstrated potential for fetal and pediatric benefit, there are significant maternal implications and complications that may occur acutely, postoperatively, for the duration of the pregnancy, and in subsequent pregnancies. Women with pregnancies complicated by fetal myelomeningocele who meet established criteria for in utero repair should be counseled in a nondirective fashion regarding all management options, including the possibility of open maternal-fetal surgery. Maternal-fetal surgery for myelomeningocele repair should be offered only to carefully selected patients at facilities with an appropriate level of personnel and resources.