In 2011, a National Institutes of Health-funded study, known as Management of Myelomeningocele Study (MOMS), showed that a surgical procedure to close the opening in the spine of a fetus with spina bifida reduced the rate of disability in the child if the surgery is performed in utero rather than after the infant has been born.

At the Fetal Care Center, which draws on the multidisciplinary expertise of Barnes-Jewish Hospital, St. Louis Children’s Hospital, and WashU Medicine physicians, patients can be treated with either the classic open prenatal surgery for spina bifida as well as a less invasive, fetoscopic procedure. The Center is one of the few in the United States and the only one in the St. Louis region offering this surgery.

For patients who are good candidates at 25 weeks, 6 days gestational age or less, fetoscopic surgery offers the following benefits over open surgery:

• Three smaller uterine incisions, each about the size of a fingernail, instead of a single large incision, decreasing subsequent complications for all pregnancies.
• Fewer activity restrictions following surgery.
• Ability to return home after the surgery and deliver at a local hospital with a NICU.
• Option to deliver vaginally in this and future pregnancies.
• Lower risk of uterine rupture in future pregnancies.

Results that exceed benchmarks

Since 2017, the Fetal Care Center has been performing open surgery to repair spina bifida, building deep experience in not only managing these high-risk pregnancies but also treating complex cases. Points of interest include:

• The shunt rate for patients who had surgery at the Fetal Care Center is 26%, which is better than the MOMS study of 40%.
• Patients' average gestational age at delivery is 35 weeks, which is greater than the MOMS’ study gestational age of 34 weeks.
• The same spinal closure featured in the open fetal technique, a multilayer watertight closure, is offered in the fetoscopic approach. Using the three-layer closure (the closing of the dura, a myofascial flap, and the skin) has resulted in no spinal cord tethering, dermoid formation, or cerebrospinal fluid leakage. Additionally, no patient has required revision after delivery.
• Patients who undergo fetoscopic surgery see the same results as patients who undergo the open procedure, a testament to the team’s rigorous training, careful planning, and commitment to excellent results.

These outcomes reflect a level of expertise and consistency that referring physicians can trust. We ensure their patients receive advanced, evidence-based care with results that meet or exceed standards.

WashU Medicine physicians are also working toward solutions to optimize outcomes for patients with fetal spina bifida diagnoses, including:

• Examining prenatal predictors for shunt placement after prenatal repair
• Identifying biomarkers for lower extremity function and hydrocephalus in amniotic fluid to be able to present personalized counseling and risk stratification
• Participating in a multicenter trial looking at sleep-disordered breathing and the impact on development in patients with spina bifida

Wesley’s story: How one family benefitted from fetoscopic repair

When Paige and Cody found out after their baby’s 20-week ultrasound that he had myelomeningocele, they were referred to the Fetal Care Center. After meeting with multiple specialists, the couple received the news that Paige was a good candidate for the fetoscopic surgery.

Paige’s surgery went smoothly, she was able to return home to the Kansas City area for the remainder of her pregnancy, and she delivered baby Wesley at 37 weeks.

For patients traveling to St. Louis for open or fetoscopic surgery, like Paige, a multidisciplinary care team at Barnes-Jewish Hospital and St. Louis Children's Hospital will help coordinate streamlined, thorough appointments. The team, which includes a personal nurse coordinator, also assists with providing lodging and access to social supports.

During surgery, mother and baby are steps away from the Level IV NICU at Children's Hospital should the fetus need to be delivered.

Today, Wesley, who is 2 1/2 years old, is doing well and has hit all his developmental milestones. He is walking, talking, and climbing, and hasn’t needed a shunt. Now that Paige and Cody have welcomed their second child, a son named Arlow, Wesley is enjoying his role as a big brother. Because Paige had the fetoscopic surgery rather than the open procedure with Wesley, she was able to have an uncomplicated pregnancy and deliver her second child vaginally.

Watch Wesley’s story below:

If you are an OB-GYN provider whose pregnant patient has received a prenatal spina bifida diagnosis, please consider learning more about the potential benefits of in utero surgery for myelomeningocele. For referrals, consult requests, emergency transfers, or questions, call 314-747-6539.