NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Process IP
ID number 949
Description Open prenatal repair for open neural tube defects is done before 26 weeks of pregnancy. Using general anaesthesia, a low transverse laparotomy incision is done and the gravid uterus is exposed and exteriorised. The fetus and placenta are visualised by ultrasound and the fetus is manually positioned to allow a uterine incision (hysterotomy) over the centre of the myelomeningocele sac. The hysterotomy location is either anterior, fundal or posterior depending on the location of the placenta. The hysterotomy is made large enough to allow the neural tissue in the meningomyelocele to be dissected from surrounding tissue so that it can drop into the spinal canal. The defect is then closed. If there is insufficient dura or skin for closure, a dermal regeneration patch substitute can be used for repair. The uterine incision is closed and a sodium lactate solution with antibiotics is added to the uterus until the amniotic fluid index is normal. The maternal abdominal wound is then closed. A number of variations to the procedure have been described.

Provisional Schedule

Expected publication 29 January 2020

Timeline

Key events during the development of the guidance:

Date Update
26 September 2019 - 24 October 2019 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance