{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T10:34:21Z","timestamp":1790332461085,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T00:00:00Z","timestamp":1530835200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Describe outcomes of open fetal surgery for myelomeningocele (<jats:styled-content style=\"fixed-case\">MMC<\/jats:styled-content>) repair in two Brazilian hospitals and the impact of surgical experience on outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Sao Paulo, Brazil.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>237 pregnant women carrying a fetus with an open spinal defect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Surgical details, and maternal and fetal outcomes collected from all patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Analysis of surgical and perinatal outcome parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total surgical time was 119 \u00b1 7.6 minutes. Preterm labour occurred in 24.2%, premature rupture of membranes in 26.7%, placental abruption in 0.8%, need for a blood transfusion at delivery in 2.1%, and dehiscence at the repair site in 2.5%. Reversal of hindbrain herniation at birth occurred in 71.4%. There were no maternal deaths or severe maternal morbidities. The failure rate with the patient anaesthetised was 0.42% and perinatal mortality was 2.1% (three intrauterine demises and two neonatal deaths). Comparing results from our study in the first 3 years with the last 3 years demonstrated improvement in the total surgical time (121.2 \u00b1 6.4 versus 118.5 \u00b1 8.2 minutes, <jats:italic>P<\/jats:italic> = 0.005) and an increase in reversal of hindbrain herniation at birth (64.0 versus 77.1%, <jats:italic>P<\/jats:italic> = 0.042).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our open fetal surgical approach for <jats:styled-content style=\"fixed-case\">MMC<\/jats:styled-content> was effective and results were comparable to past studies. Improvements in surgical performance and perinatal outcome increased as the surgical team became more familiar with the procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Funding<\/jats:title><jats:p>The study was funded solely by institutional funds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Brazilian experience of <jats:italic>in utero<\/jats:italic> open surgery for myelomeningocele repair.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15312","type":"journal-article","created":{"date-parts":[[2018,6,7]],"date-time":"2018-06-07T13:37:37Z","timestamp":1528378657000},"page":"1280-1286","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study"],"prefix":"10.1111","volume":"125","author":[{"given":"AF","family":"Moron","sequence":"first","affiliation":[{"name":"Department of 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