Subsequent fertility, pregnancy, and gynaecological and psychological outcomes after maternal-fetal surgery for open spina bifida: A prospective cohort study

Abstract

Objective: To determine the medium-term maternal impact of open fetal spina bifida repair.

Design: Prospective cohort study.

Setting: University Hospitals Leuven, Belgium.

Population: Mothers who had open maternal-fetal spina bifida repair between March 2012 and December 2021.

Methods: A patient-reported survey on subsequent fertility, pregnancy, and gynaecological and psychological outcomes.

Main outcome measures: Complications during subsequent pregnancies, and gynaecological and psychological problems.

Results: 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.

Conclusions: 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.

Keywords: fertility; fetal surgery; gynaecological outcome; pregnancy outcome; psychological outcome; spina bifida.