Abstract：
To determine the medium-term maternal impact of open fetal spina bifida repair.
Prospective cohort study.
University Hospitals Leuven, Belgium.
Mothers who had open maternal-fetal spina bifida repair between March 2012 and December 2021.
A patient-reported survey on subsequent fertility, pregnancy, and gynaecological and psychological outcomes.
Complications during subsequent pregnancies, and gynaecological and psychological problems.
Seventy-two out of 100 invited women completed the questionnaire (72%). Despite being advised not to, seven of 13 women attempting to conceive became pregnant within 2 years after fetal surgery and one woman delivered vaginally. Two of the 16 subsequent pregnancies were complicated by an open neural tube defect. One pregnancy was complicated by a placenta accreta and one pregnancy was complicated by a uterine rupture, both with good neonatal outcomes. Nearly half of respondents who did not attempt to conceive reported that this was because of their experience of the index pregnancy and caring for the index child. Three out of four respondents reported medium-term psychological problems, mostly anxiety for the health of the index child, fear for recurrence in subsequent pregnancies and feelings of guilt.
Open maternal-fetal surgery for spina bifida did not appear to affect fertility in our cohort. Half of the attempts to conceive took place within 2 years. One uterine rupture and one placenta accreta occurred in 16 subsequent pregnancies. Most respondents reported psychological problems linked to the index pregnancy, which reinforces the need for long-term psychological support.
Prospective cohort study.
University Hospitals Leuven, Belgium.
Mothers who had open maternal-fetal spina bifida repair between March 2012 and December 2021.
A patient-reported survey on subsequent fertility, pregnancy, and gynaecological and psychological outcomes.
Complications during subsequent pregnancies, and gynaecological and psychological problems.
Seventy-two out of 100 invited women completed the questionnaire (72%). Despite being advised not to, seven of 13 women attempting to conceive became pregnant within 2 years after fetal surgery and one woman delivered vaginally. Two of the 16 subsequent pregnancies were complicated by an open neural tube defect. One pregnancy was complicated by a placenta accreta and one pregnancy was complicated by a uterine rupture, both with good neonatal outcomes. Nearly half of respondents who did not attempt to conceive reported that this was because of their experience of the index pregnancy and caring for the index child. Three out of four respondents reported medium-term psychological problems, mostly anxiety for the health of the index child, fear for recurrence in subsequent pregnancies and feelings of guilt.
Open maternal-fetal surgery for spina bifida did not appear to affect fertility in our cohort. Half of the attempts to conceive took place within 2 years. One uterine rupture and one placenta accreta occurred in 16 subsequent pregnancies. Most respondents reported psychological problems linked to the index pregnancy, which reinforces the need for long-term psychological support.
摘要：
目的：确定开放式胎儿脊柱裂修复对中期产妇的影响。
方法：前瞻性队列研究。
方法：鲁汶大学医院，比利时。
方法：在2012年3月至2021年12月期间进行了开放式母胎脊柱裂修复的母亲。
方法：患者报告的后续生育能力调查，怀孕,以及妇科和心理的结果。
方法：后续妊娠期间的并发症，以及妇科和心理问题。
结果：100名受邀女性中有72名完成了问卷（72%）。尽管被建议不要这样做，13名试图怀孕的妇女中有7名在胎儿手术后2年内怀孕，1名妇女经阴道分娩。随后的16例怀孕中有2例因开放性神经管缺陷而复杂化。一次妊娠合并胎盘植入，一次妊娠合并子宫破裂，两者都有良好的新生儿结局。近一半没有尝试怀孕的受访者报告说，这是因为他们有索引怀孕和照顾索引孩子的经验。四分之三的受访者表示有中期心理问题,主要是对指数儿童的健康感到焦虑，害怕在随后的怀孕中复发和负罪感。
结论：在我们的队列中，脊柱裂的开放母胎手术似乎没有影响生育能力。一半的受孕尝试发生在2年内。16例随后的妊娠中发生了一次子宫破裂和一次胎盘植入。大多数受访者报告了与怀孕指数有关的心理问题，这加强了对长期心理支持的需求。
方法：前瞻性队列研究。
方法：鲁汶大学医院，比利时。
方法：在2012年3月至2021年12月期间进行了开放式母胎脊柱裂修复的母亲。
方法：患者报告的后续生育能力调查，怀孕,以及妇科和心理的结果。
方法：后续妊娠期间的并发症，以及妇科和心理问题。
结果：100名受邀女性中有72名完成了问卷（72%）。尽管被建议不要这样做，13名试图怀孕的妇女中有7名在胎儿手术后2年内怀孕，1名妇女经阴道分娩。随后的16例怀孕中有2例因开放性神经管缺陷而复杂化。一次妊娠合并胎盘植入，一次妊娠合并子宫破裂，两者都有良好的新生儿结局。近一半没有尝试怀孕的受访者报告说，这是因为他们有索引怀孕和照顾索引孩子的经验。四分之三的受访者表示有中期心理问题,主要是对指数儿童的健康感到焦虑，害怕在随后的怀孕中复发和负罪感。
结论：在我们的队列中，脊柱裂的开放母胎手术似乎没有影响生育能力。一半的受孕尝试发生在2年内。16例随后的妊娠中发生了一次子宫破裂和一次胎盘植入。大多数受访者报告了与怀孕指数有关的心理问题，这加强了对长期心理支持的需求。
