Texas Children's Fetal Center Finds Undergoing an EXIT Procedure to Have No Apparent Negative Impact on Future Reproductive Capacity

Jul 10, 2013, 08:00 ET from Texas Children's Hospital

HOUSTON, July 10, 2013 /PRNewswire-USNewswire/ -- Experts from Texas Children's Fetal Center published a study in volume 48, issue 5 of the Journal of Pediatric Surgery examining the maternal morbidity and reproductive outcomes following maternal-fetal surgery. The study focused on patients who underwent an ex-utero intrapartum treatment (EXIT) procedure, but also considered women who underwent mid-gestation open maternal fetal surgery (OMFS). Results show that undergoing an EXIT procedure has no apparent negative impact on future reproductive capacity, while in contrast undergoing OMFS remains associated with relatively morbid complications.

Concern regarding future reproductive capacity is one of the most important components associated with counseling patients considering fetal surgery.  However, up until this point, literature has been sparse with regard to maternal outcomes following fetal surgery, and there have been no published data evaluating the long-term maternal and obstetric outcomes of women following EXIT procedures.  By reviewing medical records of all women who underwent an EXIT or OMFS procedure at Texas Children's Fetal Center over a 10-year period and following-up with a telephone questionnaire, experts at Texas Children's Fetal Center were able to examine the impact on future reproductive capacity, information that will help expectant mothers who are faced with the challenge of considering fetal surgery.

"While maternal safety is always our highest priority, we also need to consider the psychosocial and reproductive implications of fetal surgery as well," explains Darrell Cass, M.D., senior author on the study, co-director of Texas Children's Fetal Center and associate professor, departments of Surgery, Pediatrics and Obstetrics and Gynecology at Baylor College of Medicine. "This study provides insight for patients into their future reproductive capacity, and should reassure patients who are considering an EXIT procedure." The study determined that reproductive outcomes and complication rates in subsequent pregnancies following EXIT procedures are similar to those seen in the general population. 

"Of note" said Dr. Michael Belfort, a Maternal Fetal Medicine specialist, Obstetrician and Gynecologist-in-Chief at Texas Children's Hospital and professor and chairman, department of obstetrics and gynecology at Baylor College of Medicine (BCM), "although the sample size of OMFS patients was smaller and the outcome in these patients was not the primary aim of the study, the findings are important from an obstetric standpoint. They suggest a much higher risk of significant maternal complications in ongoing pregnancies after open fetal surgery, as well as in subsequent pregnancies, in this group of patients. This underscores the need for development of less invasive surgical techniques that may help decrease uterus-related maternal complications."

"This paper gives us, as a medical community, a better understanding of future implications of a properly performed EXIT procedure on our patients, and I'm proud of the work our team has done," said Dr. Oluyinka O. Olutoye, co-director of Texas Children's Fetal Center and professor, departments of surgery, pediatrics and obstetrics and gynecology at Baylor College of Medicine (BCM). 

Future patients in fetal centers across the country faced with the challenge of considering fetal surgery will now be able to use the information that Texas Children's Hospital experts have gathered as a resource. Since the risk of maternal morbidity and reproductive outcomes following maternal-fetal surgery has now been evaluated and determined, healthcare providers will be able to better counsel families and discuss the psychosocial and reproductive implications of the surgery.

The study was conducted by Irving J. Zamora, Cecilia G. Ethuna, Lindsey M. Evans, Oluyinka O. Olutoye, Richard T. Ivey, Sina Haeri, Michael A. Belfort, Timothy C. Lee, and Darrell L. Cass and was based on 33 women who underwent maternal-fetal surgery at Texas Children's Fetal Center between December 2001 and December 2011. To-date, it is the most comprehensive evaluation of reproductive outcomes following-the EXIT procedure.

The complete study, called "Maternal morbidity and reproductive outcomes related to fetal surgery" can be found in the May 2013 edition of the Journal of Pediatric Surgery.

Texas Children's Maternal and Fetal Center is located at Texas Children's Pavilion for Women and is one of only a handful of facilities in the world to offer a full spectrum of maternal and fetal care. Comprehensive services include management of any complex pregnancy, genetic counseling and the full range of fetal diagnostic procedures. The Fetal Center also provides highly specialized fetal surgeries for a number of congenital malformations. Texas Children's is among the nation's leaders in providing high-risk maternal care and the diagnosis and treatment of abnormalities in unborn and newborn infants.

For more information, please visit women.texaschildrens.org/fetalcenter/.

About Texas Children's Hospital
Texas Children's Hospital, a not-for-profit organization, is committed to creating a community of healthy children through excellence in patient care, education and research. Consistently ranked among the top children's hospitals in the nation, Texas Children's has recognized Centers of Excellence in multiple pediatric subspecialties including the Cancer and Heart Centers, and operates the largest primary pediatric care network in the country. Texas Children's has recently completed a $1.5 billion expansion, which includes the Jan and Dan Duncan Neurological Research Institute; Texas Children's Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; and Texas Children's Hospital West Campus, a community hospital in suburban West Houston.  For more information on Texas Children's, go to www.texaschildrens.org. Get the latest news from Texas Children's


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