Maternal morbidity and reproductive outcomes related to fetal surgery

J Pediatr Surg. 2013 May;48(5):951-5. doi: 10.1016/j.jpedsurg.2013.02.010.


Purpose: The purpose of this manuscript was to examine the maternal morbidity and reproductive outcomes following maternal-fetal surgery with an emphasis on the EXIT procedure.

Methods: The medical records of all women who underwent an ex-utero intrapartum treatment (EXIT) procedure or mid-gestation open maternal fetal surgery (OMFS) at our center from December 2001 to December 2011 were reviewed retrospectively. Future reproductive outcomes were obtained via telephone questionnaire.

Results: Thirty-three women underwent maternal-fetal surgery. Twenty-six had EXIT, and seven had OMFS. The questionnaire response was 82% (27/33). Eighty-one percent (17/21) of the EXIT cohort desired future pregnancy. All who attempted (13/13) were successful. The majority (85%) conceived spontaneously and within 2.5 years on average. In the OMFS group, 40% experienced complications. One had uterine dehiscence, and another had uterine rupture requiring urgent delivery at 36 weeks. In subsequent pregnancies, 20% of OMFS cases were complicated by uterine rupture, and 8% of EXIT patients had uterine dehiscence. All had good maternal-fetal outcome.

Conclusion: Future reproductive capacity and complication rates in subsequent pregnancies following EXIT procedure are similar to those seen in the general population. In contrast, mid-gestation OMFS remains associated with relatively morbid complications. This evidence can help guide in counseling expectant mothers who are faced with the challenge of considering fetal surgery.

MeSH terms

  • Adult
  • Delivery, Obstetric
  • Female
  • Fetal Diseases / diagnosis
  • Fetal Diseases / surgery*
  • Fetal Therapies / adverse effects
  • Fetal Therapies / methods*
  • Gestational Age
  • Humans
  • Hysterotomy / adverse effects*
  • Infant, Newborn
  • Infant, Newborn, Diseases / surgery*
  • Parity
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Pregnancy Complications / etiology
  • Pregnancy Outcome*
  • Pregnancy Trimester, Second
  • Prenatal Diagnosis
  • Retrospective Studies
  • Surgical Wound Dehiscence / epidemiology*
  • Surgical Wound Dehiscence / etiology
  • Treatment Outcome
  • Uterine Rupture / epidemiology*
  • Uterine Rupture / etiology