====== Fetoscopic Myelomeningocele Repair Complications ======

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[[Fetoscopic myelomeningocele repair]] is a [[minimally invasive]] [[alternative]] to [[open fetal surgery]] for [[spina bifida]] [[repair]]. While it offers advantages such as reduced maternal morbidity and the possibility of vaginal delivery, it is associated with a unique set of complications. These complications can be categorized into maternal, fetal, and neonatal risks.

===== Maternal Complications =====

see [[Maternal Fetoscopic Myelomeningocele Repair Complications]]


### **Fetal Complications:**
1. **Preterm Birth:**  
   - The most significant fetal risk.  
   - Directly related to surgical intervention and membrane complications.

2. **Fetal Demise:**  
   - Rare but can occur due to surgical complications or severe preterm birth.

3. **Membrane Seal Failure:**  
   - Can lead to persistent leakage of amniotic fluid and oligohydramnios.

4. **Cord Complications:**  
   - Umbilical cord entanglement or compression may occur.  
   - Risk increases with prolonged chorioamniotic separation.

5. **Intrauterine Growth Restriction (IUGR):**  
   - May result from placental dysfunction secondary to surgical intervention.

### **Neonatal Complications:**
1. **Pulmonary Hypoplasia:**  
   - Can result from prolonged oligohydramnios.  
   - May require respiratory support at birth.

2. **Wound Dehiscence and CSF Leak:**  
   - Postnatal wound breakdown can occur, necessitating revision surgery.

3. **Hydrocephalus and Shunt Dependence:**  
   - Fetoscopic repair reduces the need for postnatal shunting compared to postnatal repair but may still be required in some cases.

4. **Lower Extremity Dysfunction:**  
   - Motor function improvement may be limited, particularly in severe cases.

5. **Neonatal Sepsis:**  
   - Premature birth and membrane rupture increase the risk of neonatal infections.

### **Long-Term Considerations:**
- **Neurodevelopmental Outcomes:**  
  - Generally improved compared to postnatal repair.  
  - Some infants may still experience cognitive and motor impairments.

- **Urological and Bowel Dysfunction:**  
  - Persistent issues despite early intervention.  
  - Requires lifelong management.

### **Conclusion:**
Fetoscopic MMC repair is an evolving technique with clear advantages but also significant complications. The balance between improved fetal neurological outcomes and risks of preterm delivery remains a primary consideration when selecting candidates for surgery. Further research and technical refinements aim to reduce complications and improve both maternal and fetal outcomes.