February 20, 2014 — In 2011, experts at CHOP’s Center for Fetal Diagnosis and Treatment (CFDT) co-led a landmark study, reported on in the New England Journal of Medicine, showing that fetal surgery for myelomeningocele (MMC) — the most serious form of spina bifida — can provide improved outcomes for families faced with this devastating condition. It was one of the most exciting developments in the history of treatment for birth defects and one that surgeons at the CFDT spent years helping pioneer.
Since the study’s release, fetal surgery — an extremely complex procedure that requires extensive experience to perform successfully — has become a rapidly emerging alternative therapy.
The increasing patient acceptance of this procedure and an increase in centers performing it led to the creation of the MMC Maternal-Fetal Management Task Force (that was initially convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development). The Task Force then developed guidelines for fetal MMC repair.
Julie S. Moldenhauer, MD, medical director of the Garbose Family Special Delivery Unit, was a member of the Task Force, joining clinicians experienced in fetal management of MMC from a handful of professional societies and organizations across the country. The group created key guidelines for teams performing fetal MMC repair, detailing the expertise and services required to be considered an established fetal therapy center, including proper surgical management, long-term care, necessary counseling and requirements for outcomes reporting.
The Task Force’s criteria were published in the February 2014 issue of the American Journal of Obstetrics & Gynecology, the official publication of the Society for Maternal-Fetal Medicine (SMFM). They are comprehensive and inclusive to ensure all the teams involved in the care of these fragile patients proceed with caution, as the CFDT’s team does, to maintain optimal patient safety.
Am J Obstet Gynecol. 2014 Feb;210(2):107-11. doi: 10.1016/j.ajog.2013.09.016. Epub 2013 Sep 18. Read the abstract.