{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:53:05Z","timestamp":1780102385623,"version":"3.54.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T00:00:00Z","timestamp":1704153600000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/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":[[2024,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine if the lower\u2010extremity neurological motor function level in fetuses with open spina bifida deteriorates within the 4\u2010week interval between a first prenatal motor assessment at around 22\u2009weeks of gestation and a second evaluation, prior to \u2018late\u2019 prenatal surgery, defined as surgery at 26\u201328\u2009weeks and, in certain situations, up to 30\u2009weeks, and to assess the association between prenatal presurgical motor\u2010function level, anatomical level of the lesion and postnatal motor\u2010function level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a two\u2010center cohort study of 94 singleton fetuses with open spina bifida which underwent percutaneous repair using the skin\u2010over\u2010biocellulose for antenatal fetoscopic repair (SAFER) technique between December 2016 and January 2022. All women underwent two prenatal systematic ultrasound evaluations, approximately 4\u2009weeks apart, with the second one being performed less than 1\u2009week before surgery, and one postnatal evaluation via physical examination within 2\u2009months of birth. Motor\u2010function classification was from spinal level T12 to S1, according to key muscle function. Each leg was analyzed separately; in case of discrepancy between the two legs, the worst motor\u2010function level was considered for analysis. Motor\u2010function\u2010level evaluations were compared with each other and with the anatomical level as observed on ultrasound. Independent predictors of a postnatal reduction in motor\u2010function level were assessed using a logistic regression model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Prenatal motor\u2010function level was assessed at a median gestational age of 22.5 (interquartile range (IQR), 20.7\u201324.3) and 26.7 (IQR, 25.4\u201327.3) weeks, with a median interval of 4.0 (IQR, 2.4\u20136.0)\u2009weeks. The median gestational age at surgery was 27.0 (IQR, 25.9\u201327.6)\u2009weeks and the postnatal examination was at median age of 0.8 (IQR, 0.3\u20135.4)\u2009months. There was no significant difference in motor\u2010function level between the two prenatal evaluations (<jats:italic>P<\/jats:italic>\u2009=\u20090.861). We therefore decided to use the second prenatal evaluation for comparison with postnatal motor function and anatomical level. Overall, prenatal and postnatal motor function evaluations were significantly different from the anatomical level (preoperative assessment, <jats:italic>P<\/jats:italic>\u2009=\u20090.0015; postnatal assessment, <jats:italic>P<\/jats:italic>\u2009=\u20090.0333). Comparing prenatal with postnatal motor\u2010function level, we found that 87.2% of babies had similar or improved motor function compared with that prior to prenatal surgery. On logistic regression analysis, lower anatomical level of defect and greater difference between anatomical level and prenatal motor\u2010function level were identified as independent predictors of postnatal motor function (odds ratio, 0.237 (95%\u2009CI, 0.095\u20130.588) (<jats:italic>P<\/jats:italic>\u2009=\u20090.002) and 3.44 (95%\u2009CI, 1.738\u20136.813) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>During a 4\u2010week interval between first ultrasound evaluation and late fetal surgical repair of open spina bifida, motor function does not change significantly, suggesting that late repair, \u2265\u200926\u2009weeks, does not impact negatively on motor\u2010function outcome. Compared with the anatomical level of the lesion, preoperative neurological motor\u2010function assessment via ultrasound is more predictive of postnatal motor function, and should be included in preoperative counseling. \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.27536","type":"journal-article","created":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T09:35:13Z","timestamp":1700127313000},"page":"53-59","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Revisiting <scp>MOMS<\/scp> criteria for prenatal repair of spina bifida: upper gestational\u2010age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function"],"prefix":"10.1002","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8643-1578","authenticated-orcid":false,"given":"L.","family":"Trigo","sequence":"first","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":"Faculty of Medicine and Health Sciences University of Barcelona Barcelona Spain"},{"name":"Obstetrics and Gynecology Department Pourtal\u00e8s Hospital Neuch\u00e2tel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. H.","family":"Chmait","sequence":"additional","affiliation":[{"name":"Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Llanes","sequence":"additional","affiliation":[{"name":"Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine University of Southern California Los Angeles CA USA"}],"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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7379-9608","authenticated-orcid":false,"given":"E.","family":"Eixarch","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":"Faculty of Medicine and Health Sciences University of Barcelona Barcelona Spain"},{"name":"Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER) Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Van Speybroeck","sequence":"additional","affiliation":[{"name":"Children's Hospital Los Angeles University of Southern California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3150-9187","authenticated-orcid":false,"given":"D. A.","family":"Lapa","sequence":"additional","affiliation":[{"name":"Fetal Therapy Program Hospital Israelita Albert Einstein S\u00e3o Paulo Brazil"},{"name":"Fetal Medicine Department Hospital Infantil Sabar\u00e1 S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15732"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2016.1247262"},{"issue":"678","key":"e_1_2_8_5_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_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26180"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23658"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000513311"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.6119"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22664"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19001"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.05.032"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.11.6745"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22145"},{"issue":"111","key":"e_1_2_8_15_1","first-page":"e1","article-title":"Endoscopic Surgery for the Antenatal Treatment of Myelomeningocele: The Cecam Trial","volume":"214","author":"Pedreira DAL","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22165"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22116"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199006000-00011"},{"issue":"178","key":"e_1_2_8_19_1","first-page":"e1","article-title":"Amniotic fluid levels of glial fibrillary acidic protein in fetal rats with retinoic acid induced myelomeningocele: A potential marker for spinal cord injury","volume":"204","author":"Danzer E","year":"2011","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15312"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1159\/000449382"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23761"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22772"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2023.100932"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.27536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T06:06:36Z","timestamp":1712037996000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.27536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1002\/uog.27536"],"URL":"https:\/\/doi.org\/10.1002\/uog.27536","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2023-04-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}