Child/Adolescent Health

More research is needed on outcomes after maternal-fetal surgery

The number of maternal-fetal surgeries increases every year, but research on the topic has not yet reached the point where it can be used to make care and policy recommendations, a new study finds. Researchers at the Vanderbilt Evidence-based Practice Center reviewed 258 published articles and found that most of the studies (116) were observational. Only three studies were randomized controlled trials, which are considered the gold standard for research.

The authors note that researchers face a number of challenges in examining maternal-fetal surgery. These include the small number of fetuses with specific conditions that can be easily grouped for studying and the wide geographic distribution of patients, yet narrow field of academic research centers. Further, researchers also contend with a lack of funds to cover the expenses of their research participants. Despite these and other challenges, research in this area has moved the practice of maternal-fetal surgery forward. For instance, when published reports found that repairing a fetus' diaphragmatic hernia did not provide better outcomes than correcting it just after birth, researchers developed new less-invasive techniques for the procedure.

The field will benefit from studies that address whether maternal-fetal surgery leads to or helps prevent prematurity complications. Additionally, the authors recommend that researchers take a long-lens look at how the child develops after surgery, how the surgery affects the child's quality of life, and how the organ that was operated on functions. The balance of potential benefits and harms will continue to be a central issue in research about fetal surgery. This study was funded in part by the Agency for Healthcare Research and Quality (Contract No. 290-07-10065).

See "Evidence to inform decisions about maternal-fetal surgery: Technical brief," by Katherine E. Hartmann, M.D., Ph.D., Melissa L. McPheeters, Ph.D., M.P.H., Nancy C. Chescheir, M.D., and others in the May 2011 Journal of Obstetrics and Gynecology 117(5), pp. 1191-1204.

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