• Adalina Sacco, Lennart Van der Veeken, Emma Bagshaw, Catherine Ferguson, Tim Van Mieghem, Anna L David, and Jan Deprest.
• Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, UK.
• Prenat. Diagn. 2019 Mar 1; 39 (4): 251-268.

ObjectiveTo establish maternal complication rates for fetoscopic or open fetal surgery.MethodsWe conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery, and after the index pregnancy.ResultsOne hundred sixty-six studies were included, reporting outcomes for open fetal (n = 1193 patients) and fetoscopic surgery (n = 9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI, 15.22-27.13) for open fetal and 6.2% (95%CI, 4.93-7.49) for fetoscopic surgery. For severe maternal complications (grades III to V Clavien-Dindo classification of surgical complications), the risk was 4.5% (95% CI 3.24-5.98) for open fetal and 1.7% (95% CI, 1.19-2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n = 175, 23.3%) was excluded for failing to report the presence or absence of maternal complications.ConclusionsMaternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures. Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies.© 2019 The Authors. Prenatal Diagnosis Published by John Wiley & Sons Ltd.

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