Recovery for Fetal Myelomeningocele Repair

The following section describes the mother’s postsurgical care.

Postoperative Orders

• Postanesthesia care: The mother is transitioned from the operating suite to the Labor and Delivery unit to be monitored hourly overnight. Fetal heart tones are assessed intermittently throughout the night.
• Continuous fetal cardiac monitoring: The mother is outfitted with an abdominal fetal cardiac monitor for the next 24 hours.
• Anesthesia: Epidural anesthesia is weaned over the first 24 hours and the catheter removed on the first postoperative day. Opioids are administered orally as needed thereafter.
• Diet: The patient is advanced to a regular diet as tolerated.
• Urologic recovery: Upon discontinuation of the epidural anesthetic, the foley catheter is removed and the patient is allowed to void spontaneously.
• Disposition: After demonstrating adequate mobility and bowel and bladder functioning, the patient is discharged (typically on the seventh postoperative day). Patients are asked to reside near the fetal center until delivery.

Postoperative Morbidity

• Prematurity: The vast majority (>60%) of fetuses are born preterm (earlier than 37 weeks of gestation). Severe prematurity (<30 weeks) was 13% in the MOMS cohort but has decreased in more recent series, suggesting a learning curve at high-volume centers (1,3,6).