Hysterotomy size in fetal spina bifida repair determines prematurity risks: a matched-controlled study.

Background: Spina bifida aperta (SBA) is a congenital defect associated with progressive deterioration in utero. Prenatal repair by hysterotomy, compared to postnatal repair, has been shown to improve neurological outcomes at the expense of an increased prematurity risk and significant maternal morbidity. Several teams proposed to reduce the dimension of the uterine incision. In a large cohort of repairs by mini-hysterotomy (≤3.5 cm), prematurity was less than what was reported in the benchmark Management of Myelomeningocele Study (MOMS), and reported comparable rates of reversal of hindbrain herniation. This comparison, however, did not take into account potential confounders.

Objective: We aimed to investigate whether prenatal SBA repair through mini-hysterotomy results in less prematurity when compared to standard hysterotomy, but adjusting for confounding factors.