Fetal surgery for myelomeningocele: initial results of a tertiary public hospital

Abstract Objective: To describe preliminary results of open fetal myelomeningocele surgeries performed at a tertiary public hospital in São Paulo, Brazil, analyzing epidemiological aspects as well as maternal and fetal perioperative complications. Methods: This retrospective cohort study included 25 pregnant women whose fetuses were diagnosed with myelomeningocele and underwent open intrauterine surgery between February 2019 and October 2023. Maternal demographic data, surgical outcomes, and neonatal variables were collected from medical records. Statistical analyses included Chi-squared test, Fisher's exact test, Mann–Whitney U test, and Pearson's correlation coefficient (r). Results: The mean gestational age (GA) at surgery was 25.7 ± 1.2 weeks, and the mean GA at delivery was 34.3 ± 2.0 weeks. Preterm birth was the most common complication (40%), followed by premature rupture of ovular membranes (32%). Two stillbirths occurred (8%) at 31 and 33 weeks of gestation. Median Apgar scores at 1 and 5 minutes were 8 and 9, respectively. Low birth weight (<2,500 g) was observed in 44% of neonates. Neonatal hospitalization was significantly longer in cases of preterm birth (p = 0.044), and intensive care unit stay was longer in deliveries before 34 weeks (p = 0.044). No correlation was found between GA at intrauterine surgery and GA at delivery (r = 0.252, p = 0.22). Conclusion: Fetal myelomeningocele surgery was successfully performed in a tertiary public hospital. However, preterm birth remains a major concern, as consistently reported in the literature. Nevertheless, the results confirm that intrauterine repair of myelomeningocele is indeed feasible in the public healthcare setting.