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- Title
The Use of Indomethacin with Complete Amniotic Fluid Replacement and Classic Hysterotomy for the Reduction of Perinatal Complications of Intrauterine Myelomeningocele Repair.
- Authors
Zamłyński, Mateusz; Zamłyński, Jacek; Horzelska, Ewa; Maruniak-Chudek, Iwona; Bablok, Rafał; Szukiewicz, Dariusz; Herman-Sucharska, Izabela; Kluczewska, Ewa; Olejek, Anita
- Abstract
<bold>Objective: </bold>This study presented outcomes of classical hysterotomy with modified antiprostaglandin therapy for intrauterine repair of foetal myelomeningocele (fMMC) performed in a single perinatal centre.<bold>Study Design: </bold>Forty-nine pregnant women diagnosed with fMMC underwent classic hysterotomy with anti-prostaglandin management, complete amniotic fluid replacement and high dose indomethacin application.<bold>Results: </bold>The average gestational age (GA) at delivery was 34.4 ± 3.4 weeks, with no births before 30 weeks GA. There were 2 foetal deaths. Complete reversal of hindbrain herniation (HH), assessed in magnetic resonance imaging at 30-31 weeks GA was found in 72% of foetuses (mostly with HH grade I prior to fMMC repair). Our protocol resulted in rare use of magnesium sulphate (6%), low incidence of chorioamniotic membrane separation - chorioamniotic membrane separation (6%), preterm premature rupture of membranes - preterm premature rupture of membranes (pPROM; 15%) and preterm labour - preterm labour (PTL; 17%). The postoperative wound continuity of the uterus was usually stable (in 72% of patients), with low frequency of scar thinning (23%).<bold>Conclusion: </bold>Our protocol results in rare use of tocolytics, and the low occurrences of CMS, pPROM and PTL in relation to other study cohorts: Management of Myelomeningocele Study, Children's Hospital of Philadelphia, and Vanderbilt University Medical Centre.
- Subjects
AMNIOTIC liquid; CHILDREN'S Hospital of Philadelphia; VANDERBILT University; MYELOMENINGOCELE; MEMBRANE separation; INDOMETHACIN; CHILDREN'S hospitals; AMNIOCENTESIS; FETAL MRI
- Publication
Fetal Diagnosis & Therapy, 2019, Vol 46, Issue 6, p415
- ISSN
1015-3837
- Publication type
journal article
- DOI
10.1159/000496811