Impact of AREDF‐UA during and after fetal spina bifida repair on postoperative, neonatal and 2‐year neurodevelopmental outcome

OBJECTIVE: Absent or reversed end diastolic flow (AREDF) in umbilical artery (UA) Doppler are known phenomena during fetal interventions such as fetal spina bifida (fSB) repair. The clinical importance of these Doppler findings and the impact on children's outcome is not yet clarified. METHODS: Between 2010 and 2019, 132 patients underwent SB repair at our center. The group with AREDF-UA was compared to the group with normal UA Doppler during the intervention. Primary endpoint was the FIGO-Score of the cardiotocography (CTG) 1, 2, and 6 hours postoperatively and their correlation to the ARED-UA flow. Secondary endpoints were the neonatal parameters and two-year neurodevelopmental outcome assessed using the Bayley Scale of Infant and Toddler Development Third Edition (Bayley-III). RESULTS: None of the fetuses showed AREDF before SB repair. In 107 patients (82%) normal UA-Doppler and in 23 (18%) AREDF-UA was observed during or immediately after SB surgery. AREDF-UA was more often observed after version of the fetus (p = 0.045). 17 (13 %) cases showed AEDF-UA and 6 (5%) cases REDF-UA. On the first day after SB surgery the AREDF-UA disappeared in all 23 cases. No significant difference in the CTGs at 1, 2, and 6 hours postoperatively and on the first postoperative day between the two groups was found (p > 0.05). GA at delivery, UA-pH, 5-minute Apgar and birth weight were comparable between both groups and there was no difference regarding the two-year neurodevelopmental outcome (p >0.05). Also the neurodevelopmental outcome did not differ between children with an absent or a reversed EDF-UA. CONCLUSIONS: The postoperative CTGs after a short-term phase of AREDF-UA during fSB repair normalize similarly as in normal UA-Doppler cases. AREDF-UA during fSB repair did not negatively influence postnatal or 2-year neurodevelopmental outcome compared with a normal UA-flow. This article is protected by copyright. All rights reserved