Open fetal surgery is becoming increasingly common, but what are the long-term effects on a mother’s uterus? The team at the St. Louis Fetal Care Institute hopes to find out through an investigator-initiated study, Evaluation of Hysterotomy Site after Open Fetal Surgery.
“Open fetal surgery for conditions such as myelomeningocele require us to make a three-inch incision in the mother’s uterus. Unlike a cesarean section where the surgical site is allowed to heal while the uterus is shrinking in size and the baby is out, open fetal surgery involves placing the baby back into the uterus to grow, stretching the incision site and possibly thinning the myometrium. There is limited research on how this incision impacts the uterus long-term,” says Dr. Emanuel (Mike) Vlastos, the maternal-fetal medicine physician who is the director of the St. Louis Fetal Care Institute. Through the study, the team hopes to determine the ongoing impact of open fetal surgery on a mother’s uterus.
The Hysterotomy Study evaluates the uterus of mothers who undergo open fetal surgery at the St. Louis Fetal Care Institute. The uterus is evaluated before and after fetal surgery, at the time delivery, and after delivery. “A sonohysterogram allows for viewing the internal aspects of the uterine wall. This assessment includes the depth, size and location of the uterine scars. This also allows for assurance of healing,” says Vlastos.
The sonohysterogram is an ultrasound examination where 20 to 30 ml of sterile fluid is injected into the uterus through the vagina, and then a vaginal ultrasound is conducted to review the hysterotomy and cesarean sites.
The primary outcomes of the study are to measure the depth and location of the scar six months or more after delivery. The secondary outcomes are to monitor future pregnancies, and to evaluate the number of days after fetal surgery delivery occurs. The study plans to follow participants through future pregnancies, and until the patients are no longer reproductive.
“We are hopeful that the results of this research will help improve fetal surgery techniques, help us better understand the impact of open fetal surgery on the uterus, and guide the care for future pregnancies in the mothers who undergo these surgeries,” says Vlastos.
The study is being funded through a grant from The Saigh Foundation, and has been approved by Saint Louis University School of Medicine Institutional Review Board (IRB). Currently eleven patients have been evaluated with several more registered as participants.