Intrauterine correction of open forms of spina bifida: comparative analysis of the results of V.I. Kulakov NMRC for OG&P of Minzdrav of Russia and the MOMS multicenter randomized trial
- Authors: Petrova U.L.1, Shmakov R.G.2, Zinenko D.Y.3, Gladkova K.A.1, Kostyukov K.V.1, Nikolaeva A.V.1, Sakalo V.A.1, Ostrik K.A.1, Chugunova L.A.1, Shramko A.V.3, Tarasenko Y.I.1, Berdichevskaya E.M.3, Balashova E.N.1, Ionov O.V.1
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Affiliations:
- Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
- V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of the Russian Federation
- Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation
- Issue: No 6 (2024)
- Pages: 27-36
- Section: Original Articles
- URL: https://journals.rcsi.science/0300-9092/article/view/260520
- DOI: https://doi.org/10.18565/aig.2024.114
- ID: 260520
Cite item
Abstract
Objective: This study aimed to evaluate the results of intrauterine correction of open forms of spina bifida performed at V.I. Kulakov NMRC for OG&P of Minzdrav of Russia and compare them with the results of the MOMS trial.
Materials and methods: This study included 30 patients with a confirmed diagnosis of meningomyelocele or fetal rachischisis who underwent intrauterine treatment at the center. The inclusion criteria were completion of a perinatal consultation at the center, maternal age over 18 years, singleton pregnancy, normal fetal karyotype, gestational age between 19 and 25+6 weeks, presence of Arnold–Chiari malformation type II, cervical length >20 mm, absence of fetal kyphosis >30°, and signed informed consent for surgical intervention. Comparisons were made with 78 women from the MOMS trial whose fetuses underwent intrauterine meningomyelocele repair. Statistical analysis was performed using the StatTech v 3.1.10 (Stattech LLC, Russia) and Prism v. software. 8.0.1 (GraphPad Software, USA).
Results: The most common complication of intrauterine correction for open forms of spina bifida was preterm birth. The mean gestational age at delivery was 33.3 weeks. Premature placental abruption and premature rupture of membranes were observed in 13.3% and 30% of cases, respectively. Delivery was performed via cesarean section in all cases. Correction of Arnold–Chiari II malformation was observed in 100% of the cases, and CSF shunt surgery was performed in one case for intraventricular hemorrhage. Obstetric and neurological outcomes were comparable to those of the MOMS randomized multicenter trial.
Conclusion: Timely diagnosis and careful selection of fetuses for intrauterine correction of open forms of spina bifida lead to regression of Arnold–Chiari II syndrome with subsequent improvements in neurological outcomes in children managed with an integrated multidisciplinary approach.
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##article.viewOnOriginalSite##About the authors
Uliana L. Petrova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Author for correspondence.
Email: u_petrova@oparina4.ru
ORCID iD: 0000-0003-0388-3104
PhD, Junior Researcher at the Innovation Development Department of the Department of Regional Cooperation and Integration, obstetrician-gynecologist at the 2nd Physiological Obstetric Department
Russian Federation, MoscowRoman G. Shmakov
V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of the Russian Federation
Email: mdshmakov@mail.ru
ORCID iD: 0000-0002-2206-1002
Dr. Med. Sci., Professor of the Russian Academy of Sciences, Director; Professor at the Academician G.M. Savelyeva Department of Obstetrics and Gynecology; Chief Non-staff Specialist in Obstetrics at Ministry of Health of Russia
Russian Federation, MoscowDmitriy Yu. Zinenko
Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation
Email: zinenko1959@mail.ru
ORCID iD: 0000-0003-0477-1016
Dr. Med. Sci., Professor, Head of the Department of Neurosurgery, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery
Russian Federation, MoscowKristina A. Gladkova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: k_gladkova@oparina4.ru
ORCID iD: 0000-0001-8131-4682
PhD, Senior Researcher at the Department of Fetal Medicine of the Institute of Obstetrics, Head of the 1st Obstetric Department of Pregnancy Pathology
Russian Federation, MoscowKirill V. Kostyukov
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: kostyukov@oparina4.ru
Dr. Med. Sci., Head of the Department of the Ultrasound and Functional Diagnosis
Russian Federation, MoscowAnastasia V. Nikolaeva
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: a_nikolaeva@oparina4.ru
PhD, Chief Physician
Russian Federation, MoscowVictoria A. Sakalo
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: v_sakalo@oparina4.ru
ORCID iD: 0000-0002-5870-4655
PhD, Junior Researcher at the Department of Obstetric and Extragenital Pathology, obstetrician-gynecologist at the 1st Obstetric Department of Pregnancy Pathology
Russian Federation, MoscowKirill A. Ostrik
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: k_ostrik@oparina4.ru
ORCID iD: 0009-0005-6064-665X
anesthesiologist and intensive care physician at the Department of Anesthesiology and Intensive Care
Russian Federation, MoscowLiliyana A. Chugunova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: chugunova@oparina4.ru
PhD, Senior Researcher at the Department of Ultrasound and Functional Diagnosis
Russian Federation, MoscowArtem V. Shramko
Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation
Email: Shramko@pedklin.ru
neurosurgeon at the Neurosurgery Department, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery
Russian Federation, MoscowYuliya I. Tarasenko
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: yu_tarasenko@oparina4.ru
ORCID iD: 0009-0005-1945-2108
Junior Researcher at the Innovation Development Department of the Department of Regional Cooperation and Integration, obstetrician-gynecologist at the Obstetric Department
Russian Federation, MoscowEvgenia M. Berdichevskaya
Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation
Email: dr.maratovna@gmail.com
ORCID iD: 0000-0001-6285-1968
neurologist, neurophysiologist at the Neurosurgery Department, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery
Russian Federation, MoscowEkaterina N. Balashova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: e_balashova@oparina4.ru
ORCID iD: 0000-0002-3741-0770
PhD, Leading Researcher at the Prof. A.G. Antonov Department of Anesthesiology and Intensive Care, Associate Professor at the Department of Neonatology of the Institute of Neonatology and Pediatrics
Russian Federation, MoscowOleg V. Ionov
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation
Email: o_ionov@oparina4.ru
ORCID iD: 0000-0002-4153-133X
Dr. Med. Sci., Head of the Prof. A.G. Antonov Department of Anesthesiology and Intensive Care; Professor at the Department of Neonatology, Faculty of Pediatrics
Russian Federation, MoscowReferences
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