Open Spina Bifida · Fetal Surgery Candidacy (MOMS)

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Fetal surgery candidacy assessment (MOMS)
   Open spina bifida — fetal surgery candidacy assessment (MOMS)? (Open spina bifida (myelomeningocele/myeloschisis) usually with Chiari II/hindbrain herniation (CSF leak → hindbrain descent → hydrocephalus); the two-hit hypothesis. US + MRI diagnosis (define the upper level of the lesion, confirm hindbrain herniation/Chiari II, ventriculomegaly, exclude associated anomalies). MOMS: in-utero repair <26 weeks reduces death/shunting, reverses hindbrain herniation, improves motor function (2+ levels better than the anatomic level).)
   • Meets MOMS: upper level T1–S1, hindbrain herniation present, 19.0–25.9 weeks, singleton, normal karyotype, no exclusion factors → Meets MOMS → assess in-utero repair
   • Does not meet/has exclusion factors (>26 weeks, no hindbrain herniation, other anomalies, severe kyphosis, maternal contraindication) → Does not meet → postnatal repair
2. [End] Meets MOMS → assess in-utero repair
   Meets MOMS candidacy: refer to a fetal therapy center to assess in-utero repair (open or fetoscopic); preoperative MRI to confirm hindbrain herniation/lesion level, US to assess lower-limb movement, karyotype/microarray, maternal evaluation; multidisciplinary informed consent (maternal hysterotomy and preterm birth risk).
3. [End] Does not meet → postnatal repair
   Not eligible for in-utero repair (>26 weeks, no hindbrain herniation, other anomalies, severe kyphosis or maternal contraindication): plan postnatal repair + hydrocephalus shunt management; complete MRI/US assessment of level and associated anomalies, genetic counseling; deliver at a center with neonatal neurosurgery.

Source guidelines & references

• Open spina bifida in-utero repair MOMS inclusion criteria and imaging assessment

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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