Gestational Age at Birth Varies by Surgical Technique in Prenatal Open Spina Bifida Repair: A Systematic Review and Meta-Analysis.

Abstract

Objective: Prenatal repair of open spina bifida has become well-established. Several surgical approaches have emerged, each focused on optimizing outcomes while minimizing risks. This study aims to compare the gestational age at delivery following the various surgical techniques.

Data sources: This systematic review and meta-analysis synthesizes data from 37 studies between 2010 and 2023.

Study eligibility criteria: Eligible studies included pregnant patients diagnosed with open spina bifida who underwent the following intrauterine repair techniques: open, mini-hysterotomy, laparotomy-assisted fetoscopic, and percutaneous fetoscopic repair.

Study appraisal and synthesis methods: The primary outcome investigated was gestational age (GA) at delivery, while secondary outcomes were preterm premature rupture of membranes (PPROM), vaginal birth, and perinatal mortality. The programming language software R (version 4.0.5) was used to execute the analysis.

Results: In this meta-analysis, 2,333 prenatal repair of open spina bifida procedures arising from 14 countries were analyzed. Of these, open repair accounted for 65.7%, mini-hysterotomy 14.4%, laparotomy-assisted fetoscopic 5.36%, and percutaneous fetoscopic 14.6%. Subgroup analyses revealed a non-significant mean GA at birth:34⁺¹ weeks for open repair, 34⁺² weeks for mini-hysterotomy, 35⁺³ weeks for laparotomy-assisted, and 32⁺³ weeks for percutaneous fetoscopic method (p=0.26). While the GA at birth was not different, there were significant differences (P<0.01) in pooled proportions of PPROM and preterm birth by surgical approach. (Overall rates: 75% and 30% respectively). Vaginal birth rates had significant subgroup differences (P<0.01), with the laparotomy-assisted fetoscopic group more likely to have vaginal deliveries (0.02, 0.04, 0.49, 0.18 for open, mini, laparotomy, and percutaneous, respectively).

Conclusions: The advanced secondary Bayesian analysis of data from this meta-analysis suggests that the mean gestational age at birth may differ among the four surgical techniques for prenatal repair of open spina bifida, with a potential advantage for the decrease in preterm births associated with a laparotomy-assisted approach. However, these findings should be interpreted cautiously, and further direct comparison studies are needed to confirm these observations.