Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele

J Perinatol. 2017 Sep;37(9):994-998. doi: 10.1038/jp.2017.75. Epub 2017 Jun 15.


Objective: Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure.

Study design: Mail survey of 1200 neonatologists, pediatric surgeons and maternal-fetal medicine specialists (MFMs).

Results: Of 1176 eligible physicians, 670 (57%) responded. Most respondents disagreed (68%, 11% strongly) that open fetal surgery places an unacceptable burden on women and their families. Most agreed (65%, 10% strongly) that denying the benefits of open maternal-fetal surgery is unfair to the future child. Most (94%) would recommend prenatal fetoscopic over open or postnatal MMC closure for a hypothetical fetoscopic technique that had similar shunt rates (40%) but decreased maternal morbidity. When the hypothetical shunt rate for fetoscopy was increased to 60%, physicians were split (49% fetoscopy versus 45% open). Views about burdens and fairness correlated with the likelihood of recommending postnatal or fetoscopic over open closure.

Conclusion: Individual and specialty-specific values may influence recommendations about prenatal surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Counseling
  • Female
  • Fetal Diseases / surgery*
  • Fetoscopy / adverse effects
  • Fetoscopy / ethics
  • Fetoscopy / psychology*
  • Gestational Age
  • Humans
  • Male
  • Maternal Death / etiology
  • Meningomyelocele / surgery*
  • Neonatologists*
  • Obstetrics*
  • Pediatricians*
  • Pregnancy
  • Risk
  • Surveys and Questionnaires