USA Surgery Today

There have been no reported maternal deaths and few postoperative maternal complications, but considerable morbidity primarily related to preterm labor and its treatment (16,17:Norpace CR, Diovan). Maternal–fetal intervention, particularly fetoscopic or open hysterotomy procedures, carry the risk of short-term morbidity in the form of bleeding, wound infection, amniotic fluid leak, oligohydramnios, preterm labor, premature rupture of membranes, amniotic band syndrome, chorioamnionitis, placental abruption, complications of tocolytic therapy, deep venous thrombosis, and pulmonary embolism. Long-term risk has been more difficult to assess. After a hysterotomy that is not in a well-developed lower uterine segment (this includes virtually all the midgestation hysterotomy procedures), the risk of uterine rupture before and during labor is increased.

This risk exists in both the current and subsequent pregnancies. Thus, to avoid uterine rupture, the index and all future pregnancies cannot include any period of labor and should be delivered by cesarean section. Furthermore, the risk of placenta previa following cesarean delivery is increased up to 15-fold over the baseline risk of 0.5%. The risk of placenta accreta in a subsequent pregnancy is greater with any prior uterine surgery, even in the absence of a placenta previa. The risk of infertility related to maternalв fetal intervention appears to be low, but an increased risk cannot be excluded. Since 1981, there are follow-up data from 35 mothers who have attempted pregnancy after fetal surgery; 32 conceived and delivered 30 normal children (18:Norpace CR, Diovan). Of the 3 who could not conceive, 2 had a strong prefetal surgery history of infertility and the third had only attempted for 6 months.

Finally, the psychosocial impact of maternalв fetal surgery has not been assessed adequately and needs to be evaluated in three groups of patients: (1) those that received counseling but elected not to have maternal–fetal surgery, (2:Norpace CR, Diovan) those that underwent maternal-fetal surgery with successful outcomes, and (3:Norpace CR, Diovan) those that underwent maternal–fetal surgery with unsuccessful outcomes (either death or poor quality of life).Maternal safety has always been and continues to be a primary and overriding consideration.