Chorioamniotic Membrane Separation after Fetal Spina Bifida Repair: Impact of CMS Size and Patient Management

Abstract

<b><i>Introduction:</i></b> Chorioamniotic membrane separation (CMS) is a known complication after fetal spina bifida (fSB) repair. This study’s goal was to analyze women’s outcomes with open fSB repair and CMS (group A) compared to the ones without (group B) and to assess the influence of CMS size and patient management. <b><i>Methods:</i></b> A total of 194 women with open fSB repair at our center were included in this retrospective study. Outcomes of group A were compared to the ones of group B. Regression analysis was performed to assess risk factors for CMS. Two subgroup analyses assessed the impact of CMS size (small [A-small] vs. large [A-large]) as well as patient management (A1 = hospitalization vs. A2 = no hospitalization) on pregnancy outcomes. <b><i>Results:</i></b> Of 194 women, 23 (11.9%) were in group A and 171 (88.1%) in group B. Preterm premature rupture of membranes (PPROMs) (69.6% vs. 24.1%, <i>p</i> = &lt;0.001), amniotic infection syndrome (AIS) (22.7% vs. 7.1%, <i>p</i> = 0.03), histologically confirmed chorioamnionitis (hCA) (40.0% vs. 14.7%, <i>p</i> = 0.03), length of hospital stay (LOS) after fSB repair (35 [19–65] vs. 17 [14–27] days), and overall LOS (43 [33–71] vs. 35 [27–46] days, <i>p</i> = 0.004) were significantly more often/longer in group A. Gestational age (GA) at delivery was significantly lower in group A compared to group B (35.3 [32.3–36.3] vs. 36.7 [34.9–37.0] weeks, <i>p</i> = 0.006). Regression analysis did not identify risk factors for CMS. Subgroup analysis comparing CMS sized in group A-small versus A-large showed higher AIS rate (42% vs. 0%, <i>p</i> = 0.04), lower LOS (22.0 [15.5–42.5] vs. 59.6 ± 24.1, <i>p</i> = 0.003). Comparison of group A1 versus A2 showed longer LOS (49.3 ± 22.8 vs. 15 [15–17.5] days, <i>p</i> &lt; 0.001), lower planned readmission rate (5.6% vs. 80%, <i>p</i> = 0.003). <b><i>Conclusion:</i></b> CMS significantly increased the risk of PPROM, AIS, hCA, caused longer LOS, and caused lower GA at delivery. Women with small CMS had higher AIS rates but shorter LOS compared to women with large CMS, while apart from LOS pregnancy outcomes did not differ regarding patient management (hospitalization after CMS yes vs. no).