Extended Criteria For Fetal Myelomeningocele Repair

Inclusion Criteria:

• Any woman with a prenatal diagnoses of myelomeningocele.
• Pre-pregnancy BMI of 35-45 kg/m2.
• Diabetes; patients will require good glycemic control
• History a previous preterm birth, as long as it was followed by a full term birth
• Structural abnormality in the fetus; abnormality must be minor, not increasing therisk of prematurity. For example cleft lip and palate, minor ventricular septaldefect, pyelectasis.
• Maternal Rh alloimmunization. Must have a low level of anti-red blood cell antibodythat is not associated with fetal disease, specifically anti-E < 1:4 or anti-M. Oralloimmunization with negative fetal red blood cell antigen status determined byamniocentesis.
• same MOMs Trial inclusion criteria with the exception of the above.

Exclusion Criteria:

• poor glycemic control (i.e., HbA1c ≥ 8%) in spite a medical antidiabetic therapy inaccordance with good clinical practice (GCP)
• presence of significant co-morbidities or complications (such as dyslipidemia,uncontrolled arterial hypertension, impaired renal function, neuropathy, retinopathy,CVD)
• severe diabetes complications or associated medical conditions (such as blindness,endstage renal failure, liver cirrhosis, malignancy, chronic congestive heart failure)
• recent (within preceding 12 months) myocardial infarction, stroke or TIA
• unstable angina pectoris
• same MOMs Trial exclusion criteria (with the exception of extended inclusion criteria)