Abstract：
Fetal and maternal risks associated with open fetal surgery (OFS) in the management of meningomyelocele (MMC) are considerable and necessitate improvement. A modified technique of hysterotomy (without a uterine stapler) and magnesium-free tocolysis (with Sevoflurane as the only uterine muscle relaxant) was implemented in our new magnesium-free tocolysis and classical hysterotomy (MgFTCH) protocol. The aim of the study was to assess the introduction of the MgFTCH protocol in reducing maternal and fetal complications. The prospective study cohort (SC) included 64 OFS performed with MgFTCH at the Fetal Surgery Centre Bytom (FSCB) (2015-2020). Fetal and maternal outcomes were compared with the retrospective cohort (RC; n = 46), and data from the Zurich Center for Fetal Diagnosis and Therapy (ZCFDT; n = 40) and the Children\'s Hospital of Philadelphia (CHOP; n = 100), all using traditional tocolysis. The analysis included five major perinatal complications (Clavien-Dindo classification, C-Dc) which developed before the end of 34 weeks of gestation (GA, gestational age). None of the newborns was delivered before 30 GA. Only two women presented with grade 3 complications and none with 4th or 5th grade (C-Dc). The incidence of perinatal death (3.3%) was comparable with the RC (4.3%) and CHOP data (6.1%). MgFTCH lowers the risk of major maternal and fetal complications.
摘要：
在脑膜脊髓膨出（MMC）的管理中，与开放式胎儿手术（OFS）相关的胎儿和产妇风险相当大，需要改进。在我们新的无镁宫腔和经典子宫切开术（MgFTCH）方案中，实施了改良的子宫切开术（无子宫吻合器）和无镁宫腔（七氟醚作为唯一的子宫肌肉松弛剂）。该研究的目的是评估MgFTCH方案在减少母体和胎儿并发症方面的引入。前瞻性研究队列（SC）包括在胎儿手术中心（FSCB）（2015-2020）使用MgFTCH进行的64个OFS。将胎儿和产妇结局与回顾性队列(RC；n=46)进行比较，以及来自苏黎世胎儿诊断和治疗中心（ZCFDT；n=40）和费城儿童医院（CHOP；n=100）的数据，都是用传统的宫缩疗法。分析包括五种主要的围产期并发症（Clavien-Dindo分类，C-Dc）在妊娠34周结束前发展（GA，胎龄）。没有新生儿在30GA之前分娩。只有两名妇女出现3级并发症，没有4级或5级（C-Dc）。围产期死亡发生率（3.3％）与RC（4.3％）和CHOP数据（6.1％）相当。MgFTCH降低了主要母体和胎儿并发症的风险。
