Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up-A Case Report.

Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No clinical or radiological signs of secondary tethering were observed. Neurological examination at 11 months postdelivery revealed cranial nerves without any signs of damage, axial hypotonia, decreased muscle tone in the lower extremities, and absent pathological reflexes. Motor development was slightly retarded. Complete untethering of the neural structures should always be performed, regardless of the surgical approach, as it is the only course of action that lowers the risk for developing secondary TSC.

The concentration of insulin-like growth factor-1 in pregnancies complicated by pregnancy-induced hypertension and/or intrauterine hypotrophy.

OBJECTIVES: The aim of the study was to compare Insulin-like Growth Factor-1 (IGF-1)concentration in pregnancies complicated by pregnancy-induced hypertension and/or intrauterine hypotrophy, and its correlation with maternal pressure and umbilical artery pulsatility and resistance indices. MATERIAL AND METHODS: 65 pairs pregnant-newborn were included to four groups: I - control, II - PIH, III - Hypotrophy, IV - PIH and Hypotrophy. In the study we analyzed cord blood IGF-1 concentration, newborns antropometry, umbilical artery pulsatility and resistance indices and maternal pressure before delivery. RESULTS: The concentration of IGF-1 was the lowest in IV group of hypotrophic newborns from pregnancies complicated by pregnancy-induced hypertension. In this group of patients there was strong negative correlation between IGF-1 concentration and maternal systolic and diastolic pressure. CONCLUSIONS: There is a strong negative correlation between IGF-1 concentration and maternal systolic pressure in group of hypotrophic newborns from pregnancies complicated by pregnancy-induced hypertension.