Gestational Age at Birth Varies by Surgical Technique in Prenatal Open Spina Bifida Repair: A Systematic Review and Meta-Analysis

( Am J Obstet Gynecol . 2025;232(6):524-537. doi: 10.1016/j.ajog.2025.02.014.) The most common type of neural tube defect (NTD) is spina bifida, which can be subdivided into open and closed types—classifications refer to the presence or absence of skin over the bony defect. Open spina bifida (OSB) can include both myelomeningocele or myeloschisis, and closed spina bifida can include spina bifida occulta and other spinal dysraphism over a large spectrum of severity. Prenatal treatment options for OSB have been the focus of research in the last few decades, with studies showing that hysterotomy repair has improved outcomes for the prevention of obstructive hydrocephalus and preservation of lower extremity motor function compared with postnatal treatment of OSB. The optimal surgical approach for prenatal treatment remains an object of debate, with four techniques currently in use: open hysterotomy (laparotomy and exteriorization of the uterus with an 8 cm incision), mini-hysterotomy (laparotomy and exteriorization of the uterus with a 2.5 to 3.5 cm incision), laparotomy-assisted fetoscopy (laparotomy and uterine exteriorization with fetoscope), and percutaneous technique using the Seldinger method for trocar placement into the uterine cavity. This study was designed to evaluate each of these methods (open repair, mini-hysterotomy, laparotomy-assisted fetoscopic, and percutaneous fetoscopic) through a systematic review by comparing gestational age at delivery (GA) across the different approaches.