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Chorioamniotic Membrane Separation following Open Fetal Surgery: Pregnancy Outcome

Wilson R.D. · Johnson M.P. · Crombleholme T.M. · Flake A.W. · Hedrick H.L. · King M. · Howell L.J. · Adzick N.S.
Departments of Surgery and Obstetrics/Gynecology, Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa., USA Fetal Diagn Ther 2003;18:314–320 (DOI:10.1159/000071972)

Abstract

Objective: To review the incidence of posthysterotomy chorioamniotic membrane separation and delivery outcome following open fetal surgery [myelomeningocele (MMC); cystic adenomatoid malformation (CCAM); congenital diaphragmatic hernia (CDH); sacrococcygeal teratoma (SCT)]. Study Design: Retrospective review of a maternal population undergoing open fetal surgery at a single tertiary level program (1998–2001) following the initiation of close postoperative ultrasound follow-up for membrane separation. Onset of membrane separation was coded as not present (NP), immediate (<2 weeks) or delayed (>2 weeks) from day of surgery. Results: Fifty-three charts were reviewed: MMC 43, CCAM 7, CDH 1, and SCT 2. In the MMC group there were 26 NP, 8 immediate, and 9 delayed. Preterm labor occurred in 4 patients with only 2 having had membrane separation. Risk of membrane separation is increased for surgery done at less than 23 weeks gestation (p < 0.005). Delay from MMC surgery to delivery was 11.0, 9.8, 12.0 weeks for NP, immediate, and delay, respectively. In the MMC group, there were 3 neonatal deaths (NND) at 9, 9, and 21 days post surgery (PROM/PTL; chorioamnionitis, PROM/PTL, respectively). No membrane separation was present in the CCAM, CDH, and SCT cases. Conclusions: (1) Membrane separation was significantly more likely to occur if surgery was performed prior to 23 weeks. (2) Membrane separation post hysterotomy (17/50 = 34%) may be associated with an increased risk of PROM but not delivery before 30 weeks gestation. (3) Delivery prior to 33 weeks gestation for MMC groups was 12/43 (28%) with 3 NND (7%). (4) Elective delivery at 36–37 weeks gestation was possible for 43% of the fetal surgery population.

 

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