Part 1: ‘In Utero and In India’: A Multidisciplinary Paradigm for Navigating the Clinical and Logistical Landscape of Fetal Open Spina Bifida Repair

Introduction: Open spina bifida, also known as myelomeningocele (MMC), ranks among the most prevalent severe congenital defects, traditionally addressed through postnatal repair. Nevertheless, this approach fails to prevent neurological damage, reverse hindbrain herniation, or prevent hydrocephalus. To mitigate the need for numerous medical procedures, lifelong morbidities, and associated complications, fetal surgery was introduced around 30 years ago. Objectives and Methodology: This innovative surgery has since evolved into the standard therapeutic protocol for MMC, particularly following the pivotal Management of Myelomeningocele Study (MOMS) trial. First conceptualized and pioneered by Dr. Michael Harrison at the University of California in the 1980s, the encouraging findings in both animal studies and various clinical series, laid the groundwork for a prospective multicentre randomized controlled trial known as- the MOMS. It methodically evaluated the efficacy and safety of prenatal versus postnatal MMC repair, providing Level-1 evidence of success. The trial was infact terminated prematurely due to the superior outcomes associated with prenatal repair, thereby establishing open fetal MMC repair as the definitive standard of care. This discourse intends to elucidate the historical development of this extraordinary procedure, along with its justifications and benefits for both the fetus and the mother, as well as its immediate and prolonged advantages and limitations. Conclusions: Furthermore, a concise overview of the operative technique and diagnostic criteria, along with other vital resources, will be provided. Additionally, I would be sharing my personal experience on the challenges faced in the Indian population including prospective parents and doctors, which may help to alleviate the apprehensions encountered regarding this procedure.