Surgical procedure to repair spina bifida while still in the uterus may help the baby walk after birth

More than two thousand physicians, some of the top obstetric/gynecologists in the world who specialize in maternal-fetal medicine, especially high risk pregnancies, gathered today for their annual meeting in San Francisco to begin four days of intensive research presentations. Presentations each year at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting, The Pregnancy Meeting -, represent major findings in reducing high-risk pregnancies and complications.

Catherine Y. Spong, M.D., chief, pregnancy and perinatology branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, discussed the government study that she co-authored, "Management of Myelomeningocele Study" (MOMS) at the SMFM annual meeting. An article on the study appeared today in the New England Journal of Medicine.

Myelomeningocele is the most serious form of spina bifida, a condition in which the spinal column fails to close around the spinal cord and the cord protrudes through an opening in the spine.

The $22.5 million study looked at the benefits of a surgical procedure used to repair this common defect of the spine while the baby is still in the uterus. The findings reported that the procedure greatly reduced the need to divert, or shunt, fluid away from the brain. The surgical procedure consists of closing an opening at the back of the fetal spine, which is a departure from the traditional approach of operating on the infant after birth.

The fetal procedure increases the chances that a child will be able to walk without crutches or other devices.

"This research is a huge finding for our profession and our patients," stated Joshua Copel, M.D., professor of Obstetrics, Gynecology and Reproductive Science at Yale University. Copel is also president of SMFM and a clinical practitioner in prenatal ultrasound and prenatal therapy.

The study cautioned that there were risks involved and that, because the surgery is highly specialized, it should only be undertaken in facilities with experienced staff. Infants who underwent the prenatal surgery were more likely to be born premature than were the infants who had the surgery performed after birth. Mothers who underwent the procedure were at risk of a thinning or tearing of the uterus at the incision. In spite of these risks though, children who underwent the prenatal surgery did much better than those who had the surgery after birth.

In fact, the MOMS study, which planned to enroll 200 expectant mothers carrying a child with myelomeningocele, was stopped after the enrollment of 183 women because of the benefits demonstrated in children who underwent the prenatal surgery.

The study was conducted in partnership with researchers at the Children's Hospital of Philadelphia (CHOP), The UCSF Benioff Children's Hospital at the University of California, San Francisco (UCSF), Vanderbilt University Medical Center in Nashville, and the George Washington University Biostatistics Center in Washington, D.C.

"This study is an indicator of the medical advancements being made in preventing high-risk pregnancies and complications," Copel added.

Some of the studies being presented at the SMFM annual meeting include research on:

• The benefits of fetal heart rate monitoring in reducing infant mortality,
• The increased risk of morbidity in babies delivered between 36 and 38 weeks,
• The use of 30% less analgesia during labor when patients administer their own epidural analgesia,
• Folate, which found that it does not offer preterm delivery protection,
• The use of magnesium sulfate and how it may offer protection from cerebral palsy induced by magnesium sulfate,
• The use of alcohol free antibacterial mouth-rinse associated with decreased incidence of preterm birth.