Evaluation and Disposition of Fetal Myelomeningocele Repair Candidates: A Large Referral Center Experience.
Evaluation and Disposition of Fetal Myelomeningocele Repair Candidates: A Large Referral Center Experience.
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胎儿脊髓脊膜膨出修复候选者的评估和处置：大型转诊中心的经验。
DOI：
10.1159/000500451
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发表时间：
2020
影响因子：
2.2
通讯作者：
Olut
中科院分区：
文献类型：
--
作者：
Pan,EvelynT;Pallapati,Joana;Krueger,Angel;Yepez,Mayel;VanLoh,Sarah;Nassr,AhmedA;Espinoza,Jimmy;Shamshirsaz,AlirezaA;Olutoye,OluyinkaO;Mehollin-Ray,Amy;deJong,Hester;Castillo,Heidi;Castillo,Jonathan;Whitehead,WilliamE;Olut
背景胎儿脊髓脊膜膨出（fMMC）修复产生上级的结果，产后修复，并越来越多地提供在选定的fetal centers.ObjectivesTo报告fMMC转诊过程从初始转诊到评估和手术干预在一个大型fetal referral center.MethodsWe进行了一项回顾性队列研究的患者转介到德克萨斯州儿童胎儿中心的fMMC在2013年9月和2018年1月之间，审查从转诊到最终处置的过程。逐步评估包括电话采访，然后在我们的胎儿中心进行多学科咨询。我们修改了管理脊髓脊膜膨出研究的纳入和排除标准，让产妇的身体质量指数为35-40在个别basis.ResultsA共204转介进行了电话采访，175（86%）追求门诊评价，其中80（46%）合格的修复。在符合条件的患者中，37例（46%）接受了胎儿镜修复，20例（25%）接受了开放修复，17例（21%）拒绝了产前手术。在门诊评价时排除的89例不合格患者（53%）中，64例（72%）因胎儿原因排除，17例（19%）因母体原因排除。无后脑脑疝（16%）和母亲BMI和/或高血压（5%）分别是胎儿和母亲排除的最常见原因。我们的转诊人口的31%进行了胎儿surgery.ConclusionsA fMMC转介的一小部分，最终进行产前手术。逐步评估和多学科团队是大型转诊项目成功的关键。
BackgroundFetal myelomeningocele (fMMC) repair yields superior outcomes to postnatal repair and is increasingly offered at select fetal centers.ObjectivesTo report the fMMC referral process from initial referral to evaluation and surgical intervention in a large fetal referral center.MethodsWe conducted a retrospective cohort study of patients referred to Texas Children’s Fetal Center for fMMC between September 2013 and January 2018, reviewing the process from referral to final disposition. The stepwise evaluation included a phone interview followed by multidisciplinary consultation at our fetal center. We modified the Management of Myelomeningocele Study inclusion and exclusion criteria to allow a maternal body mass index of 35–40 on an individual basis.ResultsA total of 204 referrals were contacted for a phone interview; 175 (86%) pursued outpatient evaluation, and 80 (46%) of them qualified for repair. Among the eligible patients, 37 (46%) underwent fetoscopic repair, 20 (25%) underwent open repair, and 17 (21%) declined prenatal surgery. Of the 89 noneligible patients (53%) excluded upon outpatient evaluation, 64 (72%) were excluded for fetal and 17 (19%) for maternal reasons. No hindbrain herniation (16%) and maternal BMI and/or hypertension (5%) were the most common reasons for fetal and maternal exclusion, respectively. A total of 31% of our referral population underwent fetal surgery.ConclusionsA small percentage of fMMC referrals ultimately undergo prenatal surgery. Stepwise evaluation and multidisciplinary teams are key to the success of large referral programs.