Anesthesiology Pediatric Fetal Surgery for Myelomeingocele Repair Room Tips PolicyStat

Abstract

Fetal Surgery for Myelomeningocele

Authors: Bridget Pearce, M.D., Spurthy Narreddy, M.D.

Background:

In 2011, a landmark study was published in the NEJM, entitled A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele (MMC) N Eng J med 2011; 364:993-1004, which showed that prenatal repair of MMC results in better neurologic function than postnatal repair. The study was called the Management of Myelomenigocele Study (MOMS), and they found there was less need for ventriculoperitoneal shunts and better motor function with intrauterine repair. Based on this information, parents are given the option to have fetal repair of MMC before 27 weeks gestational age.

Preoperative preparation

There is a multidisciplinary meeting the day before with OB, pediatric surgery, neurosurgery, cardiology, OB anesthesia, peds anesthesia, nursing, and project planners. Issues to be discussed are maternal co-morbidities, size of MMC defect, fetal lower extremity pathology and cerebral ventricular size. The OB faculty will indicate whether the parents wish to deliver and resuscitate the fetus in the event of an intraoperative catastrophic event.

Important information for peds anesthetic: Estimated fetal weight (EFW).