Question

Describe briefly about MOMS trial.

Hint:

The MOMS trial revolutionized the management of MMC, demonstrating that in-utero surgery offers significant benefits in motor function and reduces the need for shunts, although the risks must be carefully considered.

Answer 1

The Management of Myelomeningocele Study (MOMS) trial is a landmark clinical trial that evaluated the safety and efficacy of prenatal surgery for the treatment of myelomeningocele (MMC), specifically focusing on whether in-utero repair of MMC improves outcomes compared to standard postnatal surgery.
Step 1: Purpose of the MOMS Trial:
The primary objective of the MOMS trial was to assess whether fetal surgery for MMC would lead to better outcomes in terms of motor function and the need for shunt placement for hydrocephalus. The trial aimed to provide conclusive evidence on whether prenatal surgery could offer significant advantages in improving neurological function.
Step 2: Methodology of the Trial:
1. Study Design: The MOMS trial was a multi-center, randomized controlled trial conducted in the United States. It included 183 pregnant women carrying fetuses with an open MMC diagnosed before 25 weeks of gestation.
2. Intervention: Participants were randomly assigned to either fetal surgery or standard postnatal surgery. The fetal surgery group underwent open fetal surgery to repair the MMC before 26 weeks of gestation, while the control group had postnatal surgery after birth.
3. Outcome Measures: Primary outcomes included motor function and the need for shunt placement. Secondary outcomes included neurological function and cognitive development.
Step 3: Results and Findings:
1. Improved Motor Function: The study found that fetal surgery led to better motor outcomes, with a higher proportion of children being able to walk independently compared to those who underwent postnatal surgery.
2. Reduced Need for Shunts: The need for a shunt to treat hydrocephalus was significantly reduced in the fetal surgery group.
3. Risks and Complications: The MOMS trial also highlighted the risks of fetal surgery, including preterm birth, maternal morbidity, and complications related to the surgical procedure.
Step 4: Conclusion and Impact:
The MOMS trial provided strong evidence supporting the benefits of prenatal surgery for MMC, especially in terms of improving motor function and reducing the need for shunt placement. However, the risks associated with fetal surgery mean that it should only be performed in specialized centers and in carefully selected patients.