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 repair, mini-hysterotomy, laparotomy-assisted fetoscopic repair, and percutaneous fetoscopic repair.

Study appraisal and synthesis methods: The primary outcome investigated was gestational age at delivery, while secondary outcomes were preterm premature rupture of membranes, 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, 2333 prenatal repair of open spina bifida procedures arising from 14 countries were analyzed. Of these, open repair accounted for 65.7%, mini-hysterotomy accounted for 14.4%, laparotomy-assisted fetoscopic repair accounted for 5.36%, and percutaneous fetoscopic repair accounted for 14.6%. The subgroup analyses revealed a nonsignificant mean gestational age at birth: 34⁺¹ weeks for open repair, 34⁺² weeks for mini-hysterotomy, 35⁺³ weeks for laparotomy-assisted repair, and 32⁺³ weeks for percutaneous fetoscopic repair (P=.26). While the gestational age at birth was not different, there were significant differences (P<.01) in pooled proportions of preterm premature rupture of membranes and preterm birth by surgical approach (overall rates: 75% and 30% respectively). Vaginal birth rates had significant subgroup differences (P<.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).

Conclusion: The advanced secondary Bayesian analysis of data from this meta-analysis suggests that the mean gestational age at birth may differ among the 4 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.

Keywords: meta-analysis; neural tube defect; prenatal repair; preterm birth.