Myelomeningocele Clinical Trial
Official title:
Open Spina Bifida Fetoscopic Repair Project
The aim of the study is to assess a new fetal surgery approach to repair open spina bifida. The fetal group hypothesis is to perform a minimally invasive procedure using a fetoscopic technique in order to access to amniotic cavity and make the endoscopic repair. This approach will allow investigators to make the closure of the defect and avoid the use of an hysterotomy, reducing the risk of maternal complications as uterine dehiscence (rupture), hemorrhage and preterm premature rupture of membranes (PPROM), the patient also will be able to have a vaginal delivery.
Status | Recruiting |
Enrollment | 45 |
Est. completion date | December 31, 2018 |
Est. primary completion date | December 31, 2018 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: 1. - Pregnant women - maternal age 18 years old or older and capable of consenting for their own participation in the study 2. - Singleton pregnancy 3. - Myelomeningocele with the upper boundary located between T1 and S1 4. - Evidence of hindbrain herniation (confirmed on MRI) to have Arnold Chiari type II malformation) 5. - Absence of chromosomal abnormalities and associated anomalies. 6. - Gestational age at the time of the procedure will be between 19 to 26 weeks 7. - Normal karyotype and / or normal chromosomal microarray (CMA) by invasive testing (amniocentesis or CVS). If there is a balanced translocation with normal CMA with no other anomalies the candidate can be included. Patients declining invasive testing will be excluded. Exclusion Criteria: 1. - Fetal anomaly unrelated to myelomeningocele 2. - Sever kyphosis 3. - Increased risk for preterm labor included short cervical length (<15 mm), history of incompetent cervix with or without cerclage, and previous preterm birth 4. - Placental abnormalities (previa, abruption, accreta) known at time of enrollment 5. - A prepregnancy body mass index > or equal to 35 Kg/m2 6. - Contraindications to surgery including previous hysterotomy (whether from a previous classical cesarean, uterine anomaly such as an arcuate or bicornuate uterus, mayor myomectomy resection or previous fetal surgery) in active uterine segment. 7. - Technical limitations precluding fetoscopic surgery, such as uterine fibroids, fetal membrane separation, and uterine anomalies. 8. - Maternal fetal Rh isoimmunization, Kell sensitization or neonatal alloimmune thrombocytopenia affecting the current pregnancy 9. - Maternal HIV, Hepatitis B/C status positive 10. - Maternal medical condition that is a contraindication to surgery or anesthesia |
Country | Name | City | State |
---|---|---|---|
Mexico | Hospital Christus Muguerza Alta Especialidad | Monterrey | Nuevo Leon |
Lead Sponsor | Collaborator |
---|---|
Medicina Perinatal Alta Especialidad, México | Universidad de Monterrey |
Mexico,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Capability to achieve successful closure of the myelomeningocele by fetoscopic surgery | Binary variable (yes/no) describing if the neural tube defect (myelomeningocele) has been successfully closed (placed dissected and dropped into the open spinal canal, cystic tissue resected and edges closed to the midline), by fetoscopic surgery, and without conversion to open surgery. | Time of procedure (day 0) | |
Secondary | Surgery time (minutes) | Time between the skin incision and skin closure | Time of procedure in minutes (day of surgery / day 0) | |
Secondary | Delivery gestational age (weeks and days) | Gestational age at birth | From surgery and up to 21 weeks after the procedure | |
Secondary | Premature rupture of membranes PROM (weeks and days) | Amniotic fluid leakage before onset of labor | Between the surgery to 37 weeks of pregnancy (18 weeks after repair) | |
Secondary | Chorioamnionitis | The presence or absence of an intrauterine infection | Between the surgery and delivery (up to 20 weeks after repair) | |
Secondary | Mode of delivery | Vaginal or cesarean delivery | Delivery, up to 21 weeks after surgery | |
Secondary | Neurodevelopment evaluation by Bayley Scales of infant development II | Score of the Mental Developmental Index of the Bayley Scales of Infant Development II at 24 months of age. The score ranges from 50 (minimum) to 150 (maximum). A score of <70 indicates severe developmental delay; 70-84 indicates moderate delay; >85 indicates no delay. | Up to 24 months after birth | |
Secondary | Childhood motor function on physical examination | Difference between the anatomic upper border of the lesion level and motor function based on the physical examination at 24 months of age. A positive score of 2 indicates a functional level 2 vertebrae higher than lesion level. A score of -2 indicates a function level 2 vertebrae lower than the lesion level. | 24 months after birth | |
Secondary | Ventriculoperitoneal shunt | Need for a cerebrospinal fluid shunt within the first year of life | After birth and up to 12 months |
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