Risks and Benefits
Weighing the Risks and Benefits of Prenatal Surgery for Myelomeningocele (MMC)
Every mother should have a full and complete understanding of all of the potential risks and complications that she would expose herself and her body to in order to have prenatal surgery to repair myelomeningocele (MMC). The mother derives no direct benefit from this surgery. The most analogous situation to prenatal surgery for MMC is a parent undergoing living related kidney donation for transplantation into their child. In the case of prenatal surgery for MMC, the observed risks are mostly obstetrical in nature. However, one must also consider the potential risks of general anesthesia, deep venous thrombosis, pulmonary embolism, amniotic fluid embolism, massive hemorrhage from abruption requiring hysterotomy and death. None of these complications
occurred in the MOMS trial but only 92 women were randomized to the prenatal surgery group. It is entirely possible that as more mothers undergo prenatal surgery, that these serious obstetrical complications may be observed more frequently. It is also possible that maternal complications may be seen more commonly as these procedures are undertaken by centers with limited experience with open fetal surgery. The results of the MOMS trial present another management option for mothers to consider for their baby with MMC. It is by no means the only option nor necessarily the preferred option, but an option with considerable attendant risks for both the mother and her baby.
