In Utero Surgery for Fetal Myelomeningocele: Decision-making Mechanisms and Psychological Impact of Prenatal Therapy

Overview

Myelomeningocele is a malformation of the spine and spinal cord, generally diagnosed prenatally, and responsible for a complex disability for the unborn child. In the event of continued pregnancy, in utero surgery can be performed to improve the prognosis of the children. This fetal therapy does not allow a cure and induces risks for the fetus, and for the mother, both during surgery and for her obstetric future. Currently, few studies have focused on the factors influencing the choice to resort to in utero surgery and the experience of patients and co-parents before and after this intervention. No qualitative study on the subject has been published to date.

Detailed description

The study population corresponds to all couples who have chosen to continue the pregnancy in the face of a prenatal diagnosis of myelomeningocele in their fetus as well as to resort to in utero surgery to repair this malformation. In order to obtain the largest possible sample, the study will be offered to both couples who have had open surgery and those who have had fetoscopy.

This study aims to investigate, a posteriori, the experience of couples who have chosen fetal surgery to repair a myelomeningocele.

This is a study in clinical psychology, cross-sectional observational with an approach that will be mixed, qualitative and quantitative.

In practice, the only procedures added by the research will consist of:

* an interview between the mother of the child operated on in utero and a psychologist researcher-student pair in Master 2 of psychology * an interview between the father of the child operated on in utero and a psychologist researcher-student pair in Master 2 of psychology * the completion of a decision scale by each of the parents The presence of the interview with a psychologist not planned as part of the care may lead to the modification of the usual care of the parents.

Interventions

• Other Semi-structured interviews with a psychologist
  Semi-directed interviews using an interview guide on different themes

Primary outcome measures

• Studying the experience of couples who have chosen fetal surgery [Time frame: up to 18 months]

Secondary outcome measures (2)

• Investigate the decision-making factors that contributed to the choice of prenatal surgery [Time frame: Up to 18 months]
• Evaluate the quality of the information that couples received regarding the three possibilities proposed when faced with a prenatal diagnosis of myelomeningocele [Time frame: Up to 18 months]

Eligibility criteria

Inclusion criteria

• Mothers and adult co-parents of the child with MMC operated in utero, having signed informed consent. If both members of the couple have agreed to participate, they will be received separately.
• Mother who had fetal surgery for in utero repair of a fetal myelomeningocele by laparotomy and hysterotomy aged 18 years or older at the time of surgery, and whose child affected by the surgery is at least 6 months old
• Speaking French
• Not presenting a severe psychiatric disorder altering the relationship with reality
• Patient affiliated to a social security system

Exclusion criteria

• Patient under guardianship or curatorship, deprived of liberty or unable to sign informed consent to participate in the study
• Patient under State Medical Aid

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Other

Study locations

France · 1 center

• Service de Médecine Foetale Hôpital Armand Trousseau — Paris

Identifiers

NCT: NCT06796972 · APHP230369

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗