Researchers across three US fetal surgery centers tested something different: opening the uterus and closing the spinal defect weeks before delivery, then comparing outcomes to the standard after-birth repair in a randomized trial.
The Management of Myelomeningocele Study randomized 183 pregnancies. By 30 months, 42 percent of children repaired before birth could walk without crutches or braces, compared with 21 percent of those repaired after birth, and far fewer needed a shunt for fluid on the brain.
The trial stopped early once the benefit became clear enough that continuing to assign some mothers to the after-birth group was no longer considered ethical. Prenatal repair now carries real surgical risks of its own, including premature labor, and is offered only at specialized fetal centers that can manage both patients at once.
Read the original study
Adzick et al., New England Journal of Medicine, 2011 · doi.org/10.1056/NEJMoa1014379
Two patients, one operation, before birth.
Source
- Adzick, N. S., Thom, E. A., Spong, C. Y., Brock, J. W., Burrows, P. K., Johnson, M. P., Howell, L. J., Farrell, J. A., Dabrowiak, M. E., Sutton, L. N., Gupta, N., Tulipan, N. B., D'Alton, M. E., & Farmer, D. L. (2011). A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele. New England Journal of Medicine, 364(11), 993–1004. https://doi.org/10.1056/NEJMoa1014379