Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele

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Abstract

OBJECTIVE:

Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure.

STUDY DESIGN:

Mail survey of 1200 neonatologists, pediatric surgeons and maternal-fetal medicine specialists (MFMs).

RESULTS:

Of 1176 eligible physicians, 670 (57%) responded. Most respondents disagreed (68%, 11% strongly) that open fetal surgery places an unacceptable burden on women and their families. Most agreed (65%, 10% strongly) that denying the benefits of open maternal-fetal surgery is unfair to the future child. Most (94%) would recommend prenatal fetoscopic over open or postnatal MMC closure for a hypothetical fetoscopic technique that had similar shunt rates (40%) but decreased maternal morbidity. When the hypothetical shunt rate for fetoscopy was increased to 60%, physicians were split (49% fetoscopy versus 45% open). Views about burdens and fairness correlated with the likelihood of recommending postnatal or fetoscopic over open closure.

CONCLUSION:

Individual and specialty-specific values may influence recommendations about prenatal surgery.

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