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M J Webb - One of the best experts on this subject based on the ideXlab platform.
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Treatment of placental site trophoblastic tumor with Hysterotomy and uterine reconstruction.
Obstetrics and gynecology, 1996Co-Authors: G S Leiserowitz, M J WebbAbstract:Placental site trophoblastic tumor is an unusual variant of gestational trophoblastic neoplasia that is usually confined to the uterus, although 10% of patients have metastases. Because this tumor occurs in women of reproductive age, preservation of fertility may be relevant. Therefore, local excision of placental site trophoblastic tumor by Hysterotomy may have a place in management. A 25-year-old woman, gravida 1, para 1, presented with irregular bleeding. Uterine curettage revealed intermediate trophoblasts that on immunostaining were positive for hCG and human placental lactogen, consistent with placental site trophoblastic tumor. Endovaginal ultrasonography and magnetic resonance imaging demonstrated tumor localized to the anterior fundal myometrium. The patient underwent local excision of the tumor by Hysterotomy followed by uterine reconstruction. Pathologic examination confirmed that the surgical margins were free of tumor. The patient has had no recurrence. Two subsequent pregnancies resulted in two spontaneous abortions. A third pregnancy was carried to term. The patient was delivered by cesarean because of the Hysterotomy. The Hysterotomy scar was intact at cesarean. Hysterectomy has been recommended by most authors for treatment for placental site trophoblastic tumor. In some patients with localized placental site trophoblastic tumor who desire preservation of fertility, more conservative surgical therapy may be considered.
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Treatment of placental site trophoblastic tumor with Hysterotomy and uterine reconstruction.
Obstetrics & Gynecology, 1996Co-Authors: G S Leiserowitz, M J WebbAbstract:Background Placental site trophoblastic tumor is an unusual variant of gestational trophoblastic neoplasia that is usually confined to the uterus, although 10% of patients have metastases. Because this tumor occurs in women of reproductive age, preservation of fertility may be relevant. Therefore, local excision of placental site trophoblastic tumor by Hysterotomy may have a place in management. Case A 25-year-old woman, gravida 1, para 1, presented with irregular bleeding. Uterine curettage revealed intermediate trophoblasts that on immunostaining were positive for hCG and human placental lactogen, consistent with placental site trophoblastic tumor. Endovaginal ultrasonography and magnetic resonance imaging demonstrated tumor localized to the anterior fundal myometrium. The patient underwent local excision of the tumor by Hysterotomy followed by uterine reconstruction. Pathologic examination confirmed that the surgical margins were free of tumor. The patient has had no recurrence. Two subsequent pregnancies resulted in two spontaneous abortions. A third pregnancy was carried to term. The patient was delivered by cesarean because of the Hysterotomy. The Hysterotomy scar was intact at cesarean. Conclusion Hysterectomy has been recommended by most authors for treatment for placental site trophoblastic tumor. In some patients with localized placental site trophoblastic tumor who desire preservation of fertility, more conservative surgical therapy may be considered.
Deirdre J Lyell - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for classical Hysterotomy in twin pregnancies.
Obstetrics and gynecology, 2015Co-Authors: Sarah S Osmundson, Matthew Garabedian, Amanda Yeaton-massey, Deirdre J LyellAbstract:OBJECTIVE:To describe the rate of classical Hysterotomy in twin pregnancies across gestational age and examine risk factors that increase its occurrence.METHODS:This is a secondary analysis of the Cesarean Registry, a cohort study of women who underwent a cesarean delivery or a trial of labor after
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risk factors for classical Hysterotomy by gestational age
Obstetrics & Gynecology, 2013Co-Authors: Sarah S Osmundson, Matthew Garabedian, Deirdre J LyellAbstract:OBJECTIVE To examine the likelihood of classical Hysterotomy across preterm gestational ages and to identify factors that increase its occurrence. METHODS This is a secondary analysis of a prospective observational cohort collected by the Maternal-Fetal Medicine Network of all women with singleton gestations who underwent a cesarean delivery with a known Hysterotomy. Comparisons were made based on gestational age. Factors thought to influence Hysterotomy type were studied, including maternal age, body mass index, parity, birth weight, small for gestational age (SGA) status, fetal presentation, labor preceding delivery, and emergent delivery. RESULTS Approximately 36,000 women were eligible for analysis, of whom 34,454 (95.7%) underwent low transverse Hysterotomy and 1,562 (4.3%) underwent classical Hysterotomy. The median gestational age of women undergoing a classical Hysterotomy was 32 weeks and the incidence peaked between 24 0/7 weeks and 25 6/7 weeks (53.2%), declining with each additional week of gestation thereafter (P for trend <.001). In multivariable regression, the likelihood of classical Hysterotomy was increased with SGA (n=258; odds ratio [OR] 2.71; confidence interval [CI] 1.78-4.13), birth weight 1,000 g or less (n=467; OR 1.51; CI 1.03-2.24), and noncephalic presentation (n=783; OR 2.03; CI 1.52-2.72). The likelihood of classical Hysterotomy was decreased between 23 0/7 and 27 6/7 weeks of gestation and after 32 weeks of gestation when labor preceded delivery, and increased between 28 0/7 and 31 6/7 weeks of gestation and after 32 weeks of gestation by multiparity and previous cesarean delivery. Emergent delivery did not predict classical Hysterotomy. CONCLUSIONS Fifty percent of women at 23-26 weeks of gestation who undergo cesarean delivery have a classical Hysterotomy, and the risk declines steadily thereafter. This likelihood is increased by fetal factors, especially SGA and noncephalic presentation. LEVEL OF EVIDENCE : II.
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Risk factors for classical Hysterotomy by gestational age.
Obstetrics and gynecology, 2013Co-Authors: Sarah S Osmundson, Matthew Garabedian, Deirdre J LyellAbstract:OBJECTIVE To examine the likelihood of classical Hysterotomy across preterm gestational ages and to identify factors that increase its occurrence. METHODS This is a secondary analysis of a prospective observational cohort collected by the Maternal-Fetal Medicine Network of all women with singleton gestations who underwent a cesarean delivery with a known Hysterotomy. Comparisons were made based on gestational age. Factors thought to influence Hysterotomy type were studied, including maternal age, body mass index, parity, birth weight, small for gestational age (SGA) status, fetal presentation, labor preceding delivery, and emergent delivery. RESULTS Approximately 36,000 women were eligible for analysis, of whom 34,454 (95.7%) underwent low transverse Hysterotomy and 1,562 (4.3%) underwent classical Hysterotomy. The median gestational age of women undergoing a classical Hysterotomy was 32 weeks and the incidence peaked between 24 0/7 weeks and 25 6/7 weeks (53.2%), declining with each additional week of gestation thereafter (P for trend
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single versus double layer Hysterotomy closure at primary caesarean delivery and bladder adhesions
British Journal of Obstetrics and Gynaecology, 2010Co-Authors: Yair J. Blumenfeld, Kay Daniels, Aaron B Caughey, Yasser Y Elsayed, Deirdre J LyellAbstract:Please cite this paper as: Blumenfeld Y, Caughey A, El-Sayed Y, Daniels K, Lyell D. Single- versus double-layer Hysterotomy closure at primary caesarean delivery and bladder adhesions. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02529.x. Objective To determine the association between single-layer (one running suture) and double-layer (second layer or imbricating suture) Hysterotomy closure at primary caesarean delivery and subsequent adhesion formation. Design A secondary analysis from a prospective cohort study of women undergoing first repeat caesarean section. Setting Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA. Population One hundred and twenty-seven pregnant women undergoing first repeat caesarean section. Methods Patient records were reviewed to identify whether primary caesarean hysterotomies were closed with a single or double layer. Data were analysed by Fisher’s exact tests and multivariable logistic regression. Main outcome measure Prevalence rate of pelvic and abdominal adhesions. Results Of the 127 women, primary Hysterotomy closure was single layer in 56 and double layer in 71. Single-layer Hysterotomy closure was associated with bladder adhesions at the time of repeat caesarean (24% versus 7%, P = 0.01). Single-layer closure was associated in this study with a seven-fold increase in the odds of developing bladder adhesions (odds ratio, 6.96; 95% confidence interval, 1.72–28.1), regardless of other surgical techniques, previous labour, infection and age over 35 years. There was no association between single-layer closure and other pelvic or abdominal adhesions. Conclusions Primary single-layer Hysterotomy closure may be associated with more frequent bladder adhesions during repeat caesarean deliveries. The severity and clinical implications of these adhesions should be assessed in large prospective trials.
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Single‐ versus double‐layer Hysterotomy closure at primary caesarean delivery and bladder adhesions
BJOG : an international journal of obstetrics and gynaecology, 2010Co-Authors: Yair J. Blumenfeld, Aaron B Caughey, Yasser Y El-sayed, Kay Daniels, Deirdre J LyellAbstract:Please cite this paper as: Blumenfeld Y, Caughey A, El-Sayed Y, Daniels K, Lyell D. Single- versus double-layer Hysterotomy closure at primary caesarean delivery and bladder adhesions. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02529.x. Objective To determine the association between single-layer (one running suture) and double-layer (second layer or imbricating suture) Hysterotomy closure at primary caesarean delivery and subsequent adhesion formation. Design A secondary analysis from a prospective cohort study of women undergoing first repeat caesarean section. Setting Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA. Population One hundred and twenty-seven pregnant women undergoing first repeat caesarean section. Methods Patient records were reviewed to identify whether primary caesarean hysterotomies were closed with a single or double layer. Data were analysed by Fisher’s exact tests and multivariable logistic regression. Main outcome measure Prevalence rate of pelvic and abdominal adhesions. Results Of the 127 women, primary Hysterotomy closure was single layer in 56 and double layer in 71. Single-layer Hysterotomy closure was associated with bladder adhesions at the time of repeat caesarean (24% versus 7%, P = 0.01). Single-layer closure was associated in this study with a seven-fold increase in the odds of developing bladder adhesions (odds ratio, 6.96; 95% confidence interval, 1.72–28.1), regardless of other surgical techniques, previous labour, infection and age over 35 years. There was no association between single-layer closure and other pelvic or abdominal adhesions. Conclusions Primary single-layer Hysterotomy closure may be associated with more frequent bladder adhesions during repeat caesarean deliveries. The severity and clinical implications of these adhesions should be assessed in large prospective trials.
G S Leiserowitz - One of the best experts on this subject based on the ideXlab platform.
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Treatment of placental site trophoblastic tumor with Hysterotomy and uterine reconstruction.
Obstetrics and gynecology, 1996Co-Authors: G S Leiserowitz, M J WebbAbstract:Placental site trophoblastic tumor is an unusual variant of gestational trophoblastic neoplasia that is usually confined to the uterus, although 10% of patients have metastases. Because this tumor occurs in women of reproductive age, preservation of fertility may be relevant. Therefore, local excision of placental site trophoblastic tumor by Hysterotomy may have a place in management. A 25-year-old woman, gravida 1, para 1, presented with irregular bleeding. Uterine curettage revealed intermediate trophoblasts that on immunostaining were positive for hCG and human placental lactogen, consistent with placental site trophoblastic tumor. Endovaginal ultrasonography and magnetic resonance imaging demonstrated tumor localized to the anterior fundal myometrium. The patient underwent local excision of the tumor by Hysterotomy followed by uterine reconstruction. Pathologic examination confirmed that the surgical margins were free of tumor. The patient has had no recurrence. Two subsequent pregnancies resulted in two spontaneous abortions. A third pregnancy was carried to term. The patient was delivered by cesarean because of the Hysterotomy. The Hysterotomy scar was intact at cesarean. Hysterectomy has been recommended by most authors for treatment for placental site trophoblastic tumor. In some patients with localized placental site trophoblastic tumor who desire preservation of fertility, more conservative surgical therapy may be considered.
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Treatment of placental site trophoblastic tumor with Hysterotomy and uterine reconstruction.
Obstetrics & Gynecology, 1996Co-Authors: G S Leiserowitz, M J WebbAbstract:Background Placental site trophoblastic tumor is an unusual variant of gestational trophoblastic neoplasia that is usually confined to the uterus, although 10% of patients have metastases. Because this tumor occurs in women of reproductive age, preservation of fertility may be relevant. Therefore, local excision of placental site trophoblastic tumor by Hysterotomy may have a place in management. Case A 25-year-old woman, gravida 1, para 1, presented with irregular bleeding. Uterine curettage revealed intermediate trophoblasts that on immunostaining were positive for hCG and human placental lactogen, consistent with placental site trophoblastic tumor. Endovaginal ultrasonography and magnetic resonance imaging demonstrated tumor localized to the anterior fundal myometrium. The patient underwent local excision of the tumor by Hysterotomy followed by uterine reconstruction. Pathologic examination confirmed that the surgical margins were free of tumor. The patient has had no recurrence. Two subsequent pregnancies resulted in two spontaneous abortions. A third pregnancy was carried to term. The patient was delivered by cesarean because of the Hysterotomy. The Hysterotomy scar was intact at cesarean. Conclusion Hysterectomy has been recommended by most authors for treatment for placental site trophoblastic tumor. In some patients with localized placental site trophoblastic tumor who desire preservation of fertility, more conservative surgical therapy may be considered.
Deborah R. Berman - One of the best experts on this subject based on the ideXlab platform.
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Fetal Surgery in the Primate 4.0: A New Technique 30 Years Later.
Fetal diagnosis and therapy, 2020Co-Authors: Erin E. Perrone, Alice F. Tarantal, Laura A. Galganski, Katie J Olstad, Marjorie C. Treadwell, Deborah R. Berman, Marcus D. Jarboe, George B. Mychaliska, Diana L FarmerAbstract:Introduction Open fetal surgery requires a hemostatic Hysterotomy that minimizes membrane separation. For over 30 years, the standard of care for Hysterotomy in the gravid uterus has been the AutoSuture Premium Poly CS*-57 stapler. Objective In this study, we sought to test the feasibility of Hysterotomy in a rhesus monkey model with the Harmonic ACE®+7 Shears. Methods A gravid rhesus monkey underwent midgestation Hysterotomy at approximately 90 days of gestation (2nd trimester; term = 165 ± 10 days) using the Harmonic ACE®+7 Shears. A two-layer uterine closure was completed and the dam was monitored by ultrasound intermittently throughout the pregnancy. At 58 days after Hysterotomy (near term), a final surgery was performed to evaluate the uterus and Hysterotomy site. Results A 3.5-cm Hysterotomy was completed in 2 min 7 s. The opening was hemostatic and the membranes were sealed. Immediately after closure and throughout the pregnancy, ultrasound revealed intact membranes without separation and normal amniotic fluid levels. At term, the scar was well healed without signs of thinning or dehiscence. Conclusions The Harmonic ACE®+7 Shears produced a hemostatic midgestation Hysterotomy with membrane sealing in the rhesus monkey model. Importantly, healing was acceptable.
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An Early Investigation into Possible Alternatives to Stapled Hysterotomy in Open Fetal Surgery
American Journal of Perinatology, 2018Co-Authors: Joseph T. Church, Marjorie C. Treadwell, Jennifer S. Mcleod, Megan A. Coughlin, Ingrid L. Bergin, Elena M. Perkins, Hayley R. Hoffman, Mark Bilger, Alvaro Rojas-pena, Deborah R. BermanAbstract:Purpose We hypothesized that surgical energy could be used to create hysterotomies in open fetal surgery. Study Design Initial studies compared the LigaSure Impact and Harmonic ACE + 7 Shears in the efficiency of Hysterotomy and thermal damage. Pregnant ewes at an estimated gestational age (EGA) of 116 to 120 days (term = 145; n = 7) underwent Hysterotomy using either device. Hysterotomy edges were resected, and thermal injury extent was determined by histopathological assessment. Upon determining a superior device, subsequent studies compared this to the AutoSuture Premium Poly CS*-57 Stapler in uterine healing. Pregnant ewes (n = 6) at an EGA of 87 to 93 days underwent 6-cm Hysterotomy in each gravid horn with either the stapler (n = 5) or Harmonic (n = 5) followed by closure and animal recovery. After 37 to 42 days, uterine healing was assessed by evaluating tensile strength and histopathology. Results Thermal damage was more extensive with the LigaSure (n = 11 hysterotomies) than with the Harmonic (n = 11; 5.6 ± 1 vs. 3.1 ± 0.6 mm; p Conclusion The Harmonic ACE + 7 caused less thermal injury than the LigaSure Impact and performed similar to the CS*-57 Stapler in uterine healing with continued gestation.
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An Early Investigation into Possible Alternatives to Stapled Hysterotomy in Open Fetal Surgery.
American journal of perinatology, 2018Co-Authors: Joseph T. Church, Marjorie C. Treadwell, Jennifer S. Mcleod, Megan A. Coughlin, Ingrid L. Bergin, Elena M. Perkins, Hayley R. Hoffman, Mark Bilger, Alvaro Rojas-pena, Deborah R. BermanAbstract:We hypothesized that surgical energy could be used to create hysterotomies in open fetal surgery. Initial studies compared the LigaSure Impact and Harmonic ACE + 7 Shears in the efficiency of Hysterotomy and thermal damage. Pregnant ewes at an estimated gestational age (EGA) of 116 to 120 days (term = 145; n = 7) underwent Hysterotomy using either device. Hysterotomy edges were resected, and thermal injury extent was determined by histopathological assessment. Upon determining a superior device, subsequent studies compared this to the AutoSuture Premium Poly CS*-57 Stapler in uterine healing. Pregnant ewes (n = 6) at an EGA of 87 to 93 days underwent 6-cm Hysterotomy in each gravid horn with either the stapler (n = 5) or Harmonic (n = 5) followed by closure and animal recovery. After 37 to 42 days, uterine healing was assessed by evaluating tensile strength and histopathology. Thermal damage was more extensive with the LigaSure (n = 11 hysterotomies) than with the Harmonic (n = 11; 5.6 ± 1 vs. 3.1 ± 0.6 mm; p < 0.0001);therefore, the Harmonic was selected for healing studies. Gross scar appearance and tensile strength were the same between the Harmonic and stapler. The stapler caused more fibrosis (4/7 samples with "moderate" fibrosis vs. 0/8 with the Harmonic; p = 0.02). The Harmonic ACE + 7 caused less thermal injury than the LigaSure Impact and performed similar to the CS*-57 Stapler in uterine healing with continued gestation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Agnieszka Pastuszka - One of the best experts on this subject based on the ideXlab platform.
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Alternative Hysterotomy Technique for the Reduction of Prenatal Complications of Intrauterine Myelomeningocele Repair.
Fetal diagnosis and therapy, 2020Co-Authors: Anita Olejek, Ewa Horzelska, Jacek Zamłyński, Tomasz Horzelski, Mateusz Zamłyński, Leszek Nowak, Agnieszka PastuszkaAbstract:The main aim of the fetal surgery of myelomeningocele (MMC) is the improvement in prognosis for children with this defect and at the same time high safety of the procedure for mother and fetus. The aim of the study was to determine the effectiveness of alternative Hysterotomy technique for fetal surgery of MMC in prevention of essential perinatal complications. Forty-nine pregnant women diagnosed with fetal MMC (fMMC) who underwent classic Hysterotomy without the use of stapler formed the study cohort. Two cases of intrauterine fetal death or neonatal death in the immediate perioperative period in the study group (SG) were excluded from further analyses. In the historical control group (46 patients) from our center Hysterotomy was performed according to Management of Myelomeningocele Study (MOMS) protocol. The study cohort's outcomes were compared with the historical controls and with post-MOMS results in Children's Hospital of Philadelphia (CHOP) and Vanderbilt University Medical Center (VUMC). In the SG we did not observe delivery before 30 weeks of gestation (0/47; 0%) and the incidence of chorionamniotic membrane separation (CMS, 3/47; 6%) and preterm premature rupture of membranes (PPROM, 7/47; 15%) was lower compared to the other groups. Preterm delivery as a result of uterine contractions occurred significantly less frequently in the SG (8/47; 17%). Fetal surgery with classic Hysterotomy resulted in rare use of magnesium sulfate (3/47; 6%). The alternative Hysterotomy technique for fetal surgery of MMC results in low occurrences of CMS, PPROM, preterm delivery, and the rare use of tocolytics. © 2020 S. Karger AG, Basel.
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Alternative Hysterotomy Technique for the Reduction of Prenatal Complications of Intrauterine Myelomeningocele Repair
Fetal Diagnosis and Therapy, 2020Co-Authors: Anita Olejek, Ewa Horzelska, Jacek Zamłyński, Tomasz Horzelski, Mateusz Zamłyński, Leszek Nowak, Agnieszka PastuszkaAbstract:<b><i>Introduction:</i></b> The main aim of the fetal surgery of myelomeningocele (MMC) is the improvement in prognosis for children with this defect and at the same time high safety of the procedure for mother and fetus. <b><i>Objective:</i></b> The aim of the study was to determine the effectiveness of alternative Hysterotomy technique for fetal surgery of MMC in prevention of essential perinatal complications. <b><i>Methods:</i></b> Forty-nine pregnant women diagnosed with fetal MMC (fMMC) who underwent classic Hysterotomy without the use of stapler formed the study cohort. Two cases of intrauterine fetal death or neonatal death in the immediate perioperative period in the study group (SG) were excluded from further analyses. In the historical control group (46 patients) from our center Hysterotomy was performed according to Management of Myelomeningocele Study (MOMS) protocol. The study cohort’s outcomes were compared with the historical controls and with post-MOMS results in Children’s Hospital of Philadelphia (CHOP) and Vanderbilt University Medical Center (VUMC). <b><i>Results:</i></b> In the SG we did not observe delivery before 30 weeks of gestation (0/47; 0%) and the incidence of chorionamniotic membrane separation (CMS, 3/47; 6%) and preterm premature rupture of membranes (PPROM, 7/47; 15%) was lower compared to the other groups. Preterm delivery as a result of uterine contractions occurred significantly less frequently in the SG (8/47; 17%). Fetal surgery with classic Hysterotomy resulted in rare use of magnesium sulfate (3/47; 6%). <b><i>Conclusions:</i></b> The alternative Hysterotomy technique for fetal surgery of MMC results in low occurrences of CMS, PPROM, preterm delivery, and the rare use of tocolytics.
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learning curves of open and endoscopic fetal spina bifida closure systematic review and meta analysis
Ultrasound in Obstetrics & Gynecology, 2020Co-Authors: Luc Joyeux, Cleisson Fábio Andrioli Peralta, Agnieszka Pastuszka, Enrico Danzer, Francesca Maria Russo, A Javaux, A A F De Salles, A Olejek, T Van MieghemAbstract:OBJECTIVE The Management of Myelomeningocele Study (MOMS) trial demonstrated the safety and efficacy of open fetal surgery for spina bifida aperta (SBA). Recently developed alternative techniques may reduce maternal risks without compromising the fetal neuroprotective effects. The aim of this systematic review was to assess the learning curve (LC) of different fetal SBA closure techniques. METHODS MEDLINE, Web of Science, EMBASE, Scopus and Cochrane databases and the gray literature were searched to identify relevant articles on fetal surgery for SBA, without language restriction, published between January 1980 and October 2018. Identified studies were reviewed systematically and those reporting all consecutive procedures and with postnatal follow-up ≥ 12 months were selected. Studies were included only if they reported outcome variables necessary to measure the LC, as defined by fetal safety and efficacy. Two authors independently retrieved data, assessed the quality of the studies and categorized observations into blocks of 30 patients. For meta-analysis, data were pooled using a random-effects model when heterogeneous. To measure the LC, we used two complementary methods. In the group-splitting method, competency was defined when the procedure provided results comparable to those in the MOMS trial for 12 outcome variables representing the immediate surgical outcome, short-term neonatal neuroprotection and long-term neuroprotection at ≥ 12 months of age. Then, when raw patient data were available, we performed cumulative sum analysis based on a composite binary outcome defining successful surgery. The composite outcome combined four clinically relevant variables for safety (absence of extreme preterm delivery < 30 weeks, absence of fetal death ≤ 7 days after surgery) and efficacy (reversal of hindbrain herniation and absence of any neonatal treatment of dehiscence or cerebrospinal fluid leakage at the closure site). RESULTS Of 6024 search results, 17 (0.3%) studies were included, all of which had low, moderate or unclear risk of bias. Fetal SBA closure was performed using standard Hysterotomy (11 studies), mini-Hysterotomy (one study) or fetoscopy by either exteriorized-uterus single-layer closure (one study), percutaneous single-layer closure (three studies) or percutaneous two-layer closure (one study). Only outcomes for standard Hysterotomy could be meta-analyzed. Overall, outcomes improved significantly with experience. Competency was reached after 35 consecutive cases for standard Hysterotomy and was predicted to be achieved after ≥ 57 cases for mini-Hysterotomy and ≥ 56 for percutaneous two-layer fetoscopy. For percutaneous and exteriorized-uterus single-layer fetoscopy, competency was not reached in the 81 and 28 cases available for analysis, respectively, and LC prediction analysis could not be performed. CONCLUSIONS The number of cases operated is correlated with the outcome of fetal SBA closure, and the number of operated cases required to reach competency ranges from 35 for standard Hysterotomy to ≥ 56-57 for minimally invasive modifications. Our observations provide important information for institutions looking to establish a new fetal center, develop a new fetal surgery technique or train their team, and inform referring clinicians, potential patients and third parties. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.