Management of Labor and Delivery after Fetoscopic Repair of Open Neural Tube Defect [15D]

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Abstract

INTRODUCTION:

Fetal repair of open neural tube defect (NTD) improves motor/cognitive outcomes and decreases need for postnatal shunting. Cesarean delivery is mandated when this is done via hysterotomy. The fetoscopic approach has comparable neonatal benefits to the open hysterotomy approach, but allows for vaginal delivery. This study describes the outcomes for labor and delivery following fetoscopic repair.

METHODS:

Retrospective cohort study at a single institution from 2014-2017.

RESULTS:

32 patients had fetoscopic repair followed by either vaginal delivery (n = 16) or cesarean (n = 16) at 38.1 (26-40.2) and 36.3 (25.5-40.5) weeks, respectively.

RESULTS:

There were three elective cesareans (one breech with severe IUGR, one prior cesarean, one macrocephaly) at 39.0 (37.1-39.0) weeks. Thirteen cases were delivered by non-elective cesarean at 35.2 (25.5-40.5) weeks: five had urgent pre-labor indications (four abnormal FHTs, one breech with PPROM), and eight were indicated during labor (four abnormal FHTs, three suspected abruptions, one breech after labor onset).

RESULTS:

Of sixteen vaginal deliveries, three required instrumentation and one was a VBAC. Eight had a second-degree laceration.

RESULTS:

In total, 24 patients labored. Seven patients were induced at 39.0 (35.5-39.5) weeks; one required cervical ripening with dinoprostone while six were induced with oxytocin only. Two patients received labor augmentation with oxytocin. The most common oxytocin protocol started with 2 mU/min and increased 1-2 mU/min q45min; most cases received a maximum of 20 mU/min or less. The mean oxytocin exposure was 18.3+/-10.6 hours. No inductions failed.

CONCLUSION:

Induction of labor and vaginal delivery after fetoscopic NTD repair is safe with reduced maternal morbidity.

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