{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T10:33:43Z","timestamp":1790332423762,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We reported previously on an exteriorized\u2010uterus fetoscopic repair for open neural tube defect (ONTD) using a single\u2010layer closure (SLC) technique. However, because SLC was associated with a high rate of cerebrospinal fluid (CSF) leakage at birth, we developed a three\u2010layer closure (3LC) technique comprising a bovine collagen patch, a myofascial layer and a skin layer. The aims of this study were to compare SLC and 3LC in terms of intraoperative, postoperative and obstetric outcomes, as well as short\u2010term neonatal neurologic and non\u2010neurologic outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective analysis of prospectively collected data, from 32 consecutive SLC controls and 18 consecutive 3LC cases, that underwent exteriorized\u2010uterus two\u2010port fetoscopic repair of ONTD at our center, between April 2014 and December 2018. All patients satisfied the Management of Myelomeningocele Study (MOMS) criteria. Obstetric, maternal, fetal and early neonatal outcomes were compared between the SLC and 3LC groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Maternal demographics and mean gestational age (GA) at fetal surgery (25.0\u2009\u00b1\u20090.7 <jats:italic>vs<\/jats:italic> 25.0\u2009\u00b1\u20090.5\u2009weeks' gestation; <jats:italic>P<\/jats:italic>\u2009=\u20090.96), and at delivery (36.5\u2009\u00b1\u20093.5 <jats:italic>vs<\/jats:italic> 37.6\u2009\u00b1\u20093.0\u2009weeks; <jats:italic>P<\/jats:italic>\u2009=\u20090.14), were similar between the SLC and 3LC groups, respectively. The rate of preterm prelabor rupture of membranes (PPROM) &lt;\u200937\u2009weeks (28% <jats:italic>vs<\/jats:italic> 29%; <jats:italic>P<\/jats:italic>\u2009=\u20090.9), mean GA at PPROM (32.3\u2009\u00b1\u20093.4 <jats:italic>vs<\/jats:italic> 32.7\u2009\u00b1\u20091.9\u2009weeks; <jats:italic>P<\/jats:italic>\u2009=\u20090.83) and rate of vaginal delivery (50% <jats:italic>vs<\/jats:italic> 47%; <jats:italic>P<\/jats:italic>\u2009=\u20090.84) were similar for the SLC <jats:italic>vs<\/jats:italic> 3LC groups, respectively. In pregnancies that had SLC compared with those that had 3LC, there was a significantly higher incidence of CSF leakage at birth (8\/32 (25%) <jats:italic>vs<\/jats:italic> 0\/17 (0%); <jats:italic>P<\/jats:italic>\u2009=\u20090.02) and a significantly lower rate of reversal of hindbrain herniation at 6\u2009weeks postoperatively (18\/30 (60%) <jats:italic>vs<\/jats:italic> 14\/15 (93%); <jats:italic>P<\/jats:italic>\u2009=\u20090.02). The rate of infants that met the MOMS criteria for shunt placement or died before 12\u2009months of age (23\/31 (74%) <jats:italic>vs<\/jats:italic> 7\/12 (58%); <jats:italic>P<\/jats:italic>\u2009=\u20090.31) and those that required treatment for hydrocephalus by 12\u2009months (15\/32 (47%) <jats:italic>vs<\/jats:italic> 4\/12 (33%); <jats:italic>P<\/jats:italic>\u2009=\u20090.42) were similar between the SLC and 3LC groups, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Compared to SLC, 3LC preserves the fetal and obstetric benefits of fetoscopic repair and shows improved rates of CSF leakage and reversal of hindbrain herniation at 6\u2009weeks postoperatively. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.21915","type":"journal-article","created":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T08:50:50Z","timestamp":1573462250000},"page":"532-540","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Comparison of two fetoscopic open neural tube defect repair techniques: single\u2010 <i>vs<\/i> three\u2010layer closure"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7887-5737","authenticated-orcid":false,"given":"M. A.","family":"Belfort","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"},{"name":"Department of Neurosurgery Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"},{"name":"Department of Surgery Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-2723","authenticated-orcid":false,"given":"W. E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"},{"name":"Department of Neurosurgery Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6333-3177","authenticated-orcid":false,"given":"A. A.","family":"Shamshirsaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"},{"name":"Department of Surgery Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9830-2212","authenticated-orcid":false,"given":"J.","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1924-7965","authenticated-orcid":false,"given":"A. A.","family":"Nassr","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1619-3970","authenticated-orcid":false,"given":"O. O.","family":"Olutoye","sequence":"additional","affiliation":[{"name":"Department of Surgery Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8820-0706","authenticated-orcid":false,"given":"S. G.","family":"Keswani","sequence":"additional","affiliation":[{"name":"Department of Surgery Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0265-9859","authenticated-orcid":false,"given":"M.","family":"Sanz Cortes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199006000-00011"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000835"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001941"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000363182"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.07.014"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22165"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000005196"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002577"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800566"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000197359"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.109.3.409"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19104"},{"key":"e_1_2_6_15_1","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1002\/uog.19001","article-title":"Percutaneous fetoscopic closure of large open spina bifida using a bilaminar skin substitute","volume":"52","author":"Lapa DA","year":"2018","journal-title":"Ultrasound Obstet Gynecol"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13430"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13389"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1159\/000443498"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000479505"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.08.107"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21915","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.21915","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21915","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,3]],"date-time":"2023-09-03T09:20:45Z","timestamp":1693732845000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.21915"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1002\/uog.21915"],"URL":"https:\/\/doi.org\/10.1002\/uog.21915","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10]]},"assertion":[{"value":"2019-07-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}