{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:48:51Z","timestamp":1780102131242,"version":"3.54.0"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Twin pregnancy is currently an exclusion criterion for prenatal repair of open spina bifida (OSB). The main objective of this study was to report on our experience of treating twin pregnancies with OSB using the skin\u2010over\u2010biocellulose for antenatal fetoscopic repair (SAFER) technique. We also discuss reconsideration of the current exclusion criteria for fetal OSB repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eight fetuses with OSB from seven twin pregnancies underwent successful prenatal repair. Six pregnancies were dichorionic diamniotic with only one twin affected, and one was monochorionic diamniotic with both twins affected. Percutaneous fetoscopy was performed under CO<jats:sub>2<\/jats:sub> insufflation of the sac of the affected twin. Neurosurgical repair was performed using a biocellulose patch to protect the placode, with the skin sutured to hold the patch in place, with or without a myofascial flap. Neurodevelopment was assessed using the pediatric evaluation of disability inventory scale in babies older than 6\u2009months of adjusted age, whereas the Alberta scale was used for babies younger than 6\u2009months of adjusted age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All 14 fetuses were liveborn and none required additional repair. Gestational age at surgery ranged from 27.3 to 31.1\u2009weeks, and gestational age at birth ranged from 31.6 to 36.0\u2009weeks. Four out of eight affected twins developed sepsis, but had a good recovery. No sequela of prematurity was found in any of the unaffected twins. Short\u2010term neurodevelopment was normal in all evaluated unaffected twins (5\/5) and in all but one affected twins (7\/8). In the affected group, only one baby required ventriculoperitoneal shunt placement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prematurity is frequent after fetal surgery, and the risk is increased in twin pregnancy. Nevertheless, prenatal surgery using the SAFER technique is feasible, with low risk to both twins and their mother when performed by a highly experienced team. Long\u2010term cognitive assessment of the unaffected twin is needed. \u00a9 2023 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26236","type":"journal-article","created":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T05:42:59Z","timestamp":1683006179000},"page":"558-564","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3150-9187","authenticated-orcid":false,"given":"D. A.","family":"Lapa","sequence":"first","affiliation":[{"name":"Fetal Therapy Program Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"},{"name":"Fetal and Neonatal Therapy Hospital Infantil Sabar\u00e1  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. L.","family":"Ac\u00e1cio","sequence":"additional","affiliation":[{"name":"Fetal and Neonatal Therapy Hospital Infantil Sabar\u00e1  S\u00e3o Paulo Brazil"},{"name":"Department of Obstetrics and Gynecology University of Taubat\u00e9  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8643-1578","authenticated-orcid":false,"given":"L.","family":"Trigo","sequence":"additional","affiliation":[{"name":"BCNatal\u00a0\u2013\u00a0Fetal Medicine Research Center, Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u University of Barcelona  Barcelona Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS)  Barcelona Spain"},{"name":"Obstetrics and Gynecology Department Pourtal\u00e8s Hospital  Neuch\u00e2tel Switzerland"},{"name":"Faculty of Medicine and Health Sciences University of Barcelona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. T.","family":"Goncalves","sequence":"additional","affiliation":[{"name":"Fetal Therapy Program Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"},{"name":"Gynecology Section Hospital Servidor P\u00fablico Estadual de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Catissi","sequence":"additional","affiliation":[{"name":"Fetal Therapy Program Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Gato","sequence":"additional","affiliation":[{"name":"Anesthesiology Department Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Brandt","sequence":"additional","affiliation":[{"name":"Neurosurgery Department Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"issue":"678","key":"e_1_2_8_3_1","first-page":"e1","article-title":"Experience of 300 cases of prenatal fetoscopic open spina bifida repair: report of the International Fetoscopic Neural Tube Defect Repair Consortium","volume":"225","author":"Sanz Cortes M","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20308"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19001"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.05.032"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13430"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14937"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23658"},{"issue":"256","key":"e_1_2_8_10_1","first-page":"e1","article-title":"The Management of Myelomeningocele Study: full cohort 30\u2010month pediatric outcomes","volume":"218","author":"Farmer DL","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-1544"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2017.09.008"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sempedsurg.2019.07.002"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-022-01317-5"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5940"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15732"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1159\/000511365"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2019.1631793"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-1570"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2011.07.007"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22116"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1159\/000365353"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1700196"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.08.107"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100513"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000527"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5414"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2022.100593"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-014-3524-8"},{"issue":"1","key":"e_1_2_8_30_1","first-page":"51","article-title":"Motor function evolution in open spina bifida before and after \u201clate\u201d fetoscopic prenatal repair. 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