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The following is a summary of “Gestational Age at Birth Varies by Surgical Technique in Prenatal Open Spina Bifida Repair: A Systematic Review and Meta-Analysis,” published in the February 2025 issue of American Journal of Obstetrics & Gynecology by Zargarzadeh et al. 

Researchers conducted a retrospective study to compare gestational age (GA) at delivery among different surgical techniques for prenatal open spina bifida repair. 

They analyzed data from 37 studies published between 2010 and 2023. Eligible studies included pregnant patients diagnosed with open spina bifida who underwent intrauterine repair via open, mini-hysterotomy, laparotomy-assisted fetoscopic, or percutaneous fetoscopic techniques. The primary outcome analyzed was GA at delivery, while secondary outcomes included preterm premature rupture of membranes (PPROM), vaginal birth, and perinatal mortality. Data analysis was performed using the programming language software R (version 4.0.5). 

The results showed that 2,333 prenatal open spina bifida repair procedures from 14 countries were analyzed. Open repair accounted for 65.7%, mini-hysterotomy 14.4%, laparotomy-assisted fetoscopic 5.36%, and percutaneous fetoscopic 14.6%. Subgroup analysis showed no significant difference in mean GA at birth: 34+1 weeks for open repair, 34+2 weeks for mini-hysterotomy, 35+3 weeks for laparotomy-assisted, and 32+3 weeks for percutaneous fetoscopic (P =0.26). However, differences were observed in pooled proportions of PPROM and preterm birth by surgical approach (P <0.01), with overall rates of 75% and 30%, respectively. Vaginal birth rates varied significantly (P <0.01), with laparotomy-assisted fetoscopic repair showing the highest likelihood (0.02, 0.04, 0.49, and 0.18 for open, mini-hysterotomy, laparotomy-assisted, and percutaneous fetoscopic, respectively). 

Investigators concluded the mean GA at birth varied among the 4 surgical techniques for prenatal open spina bifida repair, with laparotomy-assisted repair potentially reducing preterm births. 

Source: ajog.org/article/S0002-9378(25)00094-8/abstract