{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T09:55:56Z","timestamp":1768816556419,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"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":[[2021,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe changes in fetal Doppler parameters during a novel technique for open fetal microneurosurgery for open spina bifida (OSB) repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective study of 44 fetuses undergoing open fetal surgery for OSB repair using a novel microneurosurgery approach that is characterized by a mini\u2010hysterotomy (diameter of 15\u2009mm), minimal fetal manipulation and maintenance of a constant normal amniotic fluid volume throughout the procedure. Doppler velocimetry of the umbilical artery (UA), fetal middle cerebral artery (MCA) and ductus venosus (DV) was performed before the start of surgery and at prespecified timepoints during fetal surgery. UA pulsatility index (PI) &gt;\u200995<jats:sup>th<\/jats:sup> percentile, DV\u2010PI &gt;\u200995<jats:sup>th<\/jats:sup> percentile, MCA\u2010PI &lt;\u20095<jats:sup>th<\/jats:sup> percentile and cerebroplacental ratio (CPR) &lt;\u20095<jats:sup>th<\/jats:sup> percentile were considered abnormal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median gestational age at fetal surgery was 25.2\u2009weeks (range, 22.9\u201327.9\u2009weeks). Doppler recordings were successfully obtained in all cases during all timepoints throughout the surgery. As compared with Doppler values before surgery, there was a significant increase in the proportion of fetuses with MCA\u2010PI &lt;\u20095<jats:sup>th<\/jats:sup> percentile (63.6% <jats:italic>vs<\/jats:italic> 13.6%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), CPR &lt;\u20095<jats:sup>th<\/jats:sup> percentile (65.9% <jats:italic>vs<\/jats:italic> 15.9%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and DV\u2010PI &gt;\u200995<jats:sup>th<\/jats:sup> percentile (22.7% <jats:italic>vs<\/jats:italic> 0%; <jats:italic>P<\/jats:italic>\u2009=\u20090.01) and a non\u2010significant increase in the proportion of fetuses with UA\u2010PI &gt;\u200995<jats:sup>th<\/jats:sup> percentile (11.4% <jats:italic>vs<\/jats:italic> 0%; <jats:italic>P<\/jats:italic>\u2009=\u20090.12) during fetal surgery. None of the fetuses showed absent or reversed end\u2010diastolic velocity in the UA or absent or reversed DV a\u2010wave at any stage during OSB repair. All abnormal Doppler parameters returned to normal after surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>During open fetal surgery for OSB repair, a small hysterotomy, reduced fetal manipulation and maintenance of a normal amniotic fluid volume seem to prevent severe fetal Doppler abnormalities. The mild Doppler changes observed during fetal surgery could be a manifestation of fetal adaptation to the stress of fetal surgery. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.22177","type":"journal-article","created":{"date-parts":[[2020,8,15]],"date-time":"2020-08-15T08:38:50Z","timestamp":1597480730000},"page":"238-244","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Doppler changes in umbilical artery, middle cerebral artery, cerebroplacental ratio and ductus venosus during open fetal microneurosurgery for intrauterine open spina bifida repair"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5999-866X","authenticated-orcid":false,"given":"R.","family":"Cruz\u2010Mart\u00ednez","sequence":"first","affiliation":[{"name":"Fetal Medicine and Surgery Center Medicina Fetal M\u00e9xico Quer\u00e9taro Mexico"},{"name":"Instituto de Ciencias de la Salud (ICSa) Universidad Aut\u00f3noma del Estado de Hidalgo (UAEH) Hidalgo Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"G\u00e1mez\u2010Varela","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Center Medicina Fetal M\u00e9xico Quer\u00e9taro Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6807-3578","authenticated-orcid":false,"given":"M.","family":"Cruz\u2010Lemini","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Center Medicina Fetal M\u00e9xico Quer\u00e9taro Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Mart\u00ednez\u2010Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Center Medicina Fetal M\u00e9xico Quer\u00e9taro Mexico"},{"name":"Department of Fetal Surgery Hospital de Especialidades del Ni\u00f1o y la Mujer \u201cDr. Felipe N\u00fa\u00f1ez Lara\u201d Quer\u00e9taro Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Luna\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Center Medicina Fetal M\u00e9xico Quer\u00e9taro Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"L\u00f3pez\u2010Briones","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Center Medicina Fetal M\u00e9xico Quer\u00e9taro Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Chavelas\u2010Ochoa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Especialidades del Ni\u00f1o y la Mujer \u201cDr. Felipe N\u00fa\u00f1ez Lara\u201d  Quer\u00e9taro Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Ch\u00e1vez\u2010Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Fetal 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