MATERNAL AND FETAL/INFANT PROGNOSIS AFTER INTRAUTERINE SURGERY FOR CORRECTION OF MYELOMENINGOCELE

• DOI: https://doi.org/10.22533/at.ed.15947024300710

• Palavras-chave: myelomeningocele; intrauterine surgery; prognosis.

• Keywords: myelomeningocele; intrauterine surgery; prognosis.

• Abstract:

  Myelomeningocele is the most severe and common form of spina bifida. Historically, repair was performed after birth, but fetal surgery has emerged as a promising alternative. The 2011 MOMS study showed that intrauterine surgery reduced the need for shunt and improved motor and mental function, but also presented risks such as prematurity and maternal complications. Objective: To evaluate whether intrauterine surgery for myelomeningocele repair positively impacts maternal and fetal/child prognosis compared to postnatal repair. Methodology: Literature review in PubMed and Cochrane Library platforms with specific descriptors, excluding duplicates and irrelevant articles, resulting in 10 selected studies. The MOMS (Management of Myelomeningocele Study) study was manually added. Discussion: Comparisons between studies from Zurich and MOMS showed similar results, although fetal surgery is associated with complications such as hematomas and oligohydramnios. The experience of the surgical team is crucial for the results. Studies have shown that prenatal surgery resulted in a reduced need for cerebrospinal fluid diversion and improved mobility in children. Recent studies indicate that the fetoscopy technique can provide neurological results similar to hysterotomy, with some differences in complications and surgical time. The MOMS2 study (2012-2017) confirmed that the benefits of fetal surgery are maintained until school age, with improved physical function and self-care skills in children operated on intrauterinely. Conclusion: Intrauterine surgery for myelomeningocele correction improves child prognosis, especially in neurological development and motor function. The experience of the team and the surgical center is fundamental to the results. Additional studies are needed to compare the different surgical approaches and validate these findings with greater scientific rigor.