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The Management of Myelomeningocele Study randomized women carrying fetuses with open spina bifida to prenatal surgery or standard postnatal repair. Prenatal surgery reduced the need for ventriculoperitoneal shunt placement and improved motor-function-related outcomes at 30 months, although maternal and obstetric complications were increased. The study established fetal surgery as a potential option for carefully selected pregnancies in experienced centers. For HCPs, the central lesson is that fetal therapy involves a complex maternal-fetal risk trade-off rather than a simple fetal benefit. Counseling requires detailed imaging, multidisciplinary assessment, evaluation of gestational age and lesion characteristics, and discussion of maternal risks including uterine complications and preterm birth. The MOMS trial provides a classic example of how innovation can change outcomes while simultaneously creating new procedural and ethical considerations.
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The Management of Myelomeningocele Study randomized women carrying fetuses with open spina bifida to prenatal surgery or standard postnatal repair. Prenatal surgery reduced the need for ventriculoperitoneal shunt placement and improved motor-function-related outcomes at 30 months, although maternal and obstetric complications were increased. The study established fetal surgery as a potential option for carefully selected pregnancies in experienced centers. For HCPs, the central lesson is that fetal therapy involves a complex maternal-fetal risk trade-off rather than a simple fetal benefit. Counseling requires detailed imaging, multidisciplinary assessment, evaluation of gestational age and lesion characteristics, and discussion of maternal risks including uterine complications and preterm birth. The MOMS trial provides a classic example of how innovation can change outcomes while simultaneously creating new procedural and ethical considerations.
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