Fetal-Maternal Surgery for Spina Bifida in a HIV-Infected Mother

Author:

Elrod Julia,Ochsenbein-Kölble Nicole,Mazzone LucaORCID,Zimmermann Roland,Berger Christoph,Speck Roberto F.,Strübing Nele,Mohr ChristophORCID,Moehrlen UeliORCID,Meuli Martin

Abstract

<b><i>Introduction:</i></b> In select cases, in utero surgery for myelomeningocele (MMC) leads to better outcomes than postnatal repair. However, maternal HIV infection constitutes a formal exclusion criterion due to the potential of vertical HIV transmission. Encouraged by a previous case of a successful fetal spina bifida repair in a Hepatitis Bs antigen-positive woman, a plan was devised allowing for fetal surgery. <b><i>Case Report:</i></b> In utero MMC repair was performed although the mother was HIV-infected. To minimize the risk of in utero HIV transmission, the mother was treated by highly active antiretroviral therapy throughout gestation as well as intravenous zi­dovudine administration during maternal-fetal surgery. The mother tolerated all procedures very well without any sequelae. The currently 20 month-old toddler is HIV negative and has significantly benefitted from fetal surgery. <b><i>Discussion/Conclusion:</i></b> This case shows that maternal HIV is not a priori a diagnosis that excludes fetal surgery. Rather, it might be a surrogate for moving towards personalized medicine and away from applying too rigorous exclusion criteria in the selection of candidates for maternal-fetal surgery.

Publisher

S. Karger AG

Subject

Obstetrics and Gynecology,Radiology, Nuclear Medicine and imaging,Embryology,General Medicine,Pediatrics, Perinatology and Child Health

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