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Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele

Journal of Perinatology volume 37, pages 994–998 (2017)Cite this article

Subjects

Abstract

Objective:

Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure.

Study design:

Mail survey of 1200 neonatologists, pediatric surgeons and maternal–fetal medicine specialists (MFMs).

Results:

Of 1176 eligible physicians, 670 (57%) responded. Most respondents disagreed (68%, 11% strongly) that open fetal surgery places an unacceptable burden on women and their families. Most agreed (65%, 10% strongly) that denying the benefits of open maternal–fetal surgery is unfair to the future child. Most (94%) would recommend prenatal fetoscopic over open or postnatal MMC closure for a hypothetical fetoscopic technique that had similar shunt rates (40%) but decreased maternal morbidity. When the hypothetical shunt rate for fetoscopy was increased to 60%, physicians were split (49% fetoscopy versus 45% open). Views about burdens and fairness correlated with the likelihood of recommending postnatal or fetoscopic over open closure.

Conclusion:

Individual and specialty-specific values may influence recommendations about prenatal surgery.

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Acknowledgements

Funding was provided by a grant from the Greenwall Foundation.

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Authors and Affiliations

  1. University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    R M Antiel, A W Flake, M P Johnson, N E Rintoul & C Feudtner

  2. Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA

    R M Antiel, C A Collura & J C Tilburt

  3. Department of General Surgery, Mayo Clinic, Rochester, MN, USA

    R M Antiel

  4. Division of Neonatal Medicine,

    C A Collura

  5. , Mayo Clinic, Rochester, MN, USA

    C A Collura

  6. Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, USA

    J D Lantos

  7. Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, NC, USA

    F A Curlin

  8. Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA

    J C Tilburt

  9. Department of Radiology, Boston Children’s Hospital, Boston, MA, USA

    S D Brown

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  1. R M Antiel
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Correspondence to R M Antiel.

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Antiel, R., Collura, C., Flake, A. et al. Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele. J Perinatol 37, 994–998 (2017). https://doi.org/10.1038/jp.2017.75

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