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Sacral MyelomeningocelePRIUM2NCT04770805

In Utero Fetoscopic Repair Program for Sacral Myelomeningoceles and Mye-LDM

A study testing Fetoscopy in people with Sacral Myelomeningocele and Neural Tube Defects, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The purpose of the study is to evaluate the feasibility and the maternal, fetal and postnatal outcomes of sacral myelomeningocele (MMC) and Myelic Limited Dorsal Myeloschisis (MyeLDM) fetoscopic repair at Trousseau Hospital (Paris, France). Read more about this study

Who is it for?
Ages 18 years and older, women only
What is being tested?
Fetoscopy
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10 participants
Where
1 siteFrance
Study dates
16 Apr 2021to 8 Dec 2025
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Pregnant women age 18 years and older who are able to consent
  • Singleton pregnancy before 26 weeks of gestation,
  • Sacral MMC (upper level S1 or below) or MyeLDM diagnosed on ultrasound and MRI, 4. Absence of associated malformation apart from the anomalies usually observed in cases of open dysraphisms (i.e. feet malpositions, associated cerebral signs) or chromosomal anomaly if verification of the karyotype was desired by the couple
  • Affiliated to health insurance, understanding and speaking French
  • Written consent of the patient for the surgery and representatives of the parental authority for the postnatal follow-up of the child
  • Patient who made the choice to continue the pregnancy

Who cannot join

  • Abnormal angulation of the fetal spine,
  • risk factors for prematurity: cervical length less < 15mm, history of late miscarriage before 22 weeks, pre-existing rupture of the membranes at inclusion,
  • Placenta praevia,
  • BMI greater than 35 kg / m2,
  • Abnormality of the uterus: large fibroid, uterine malformation, history of uterine body surgery
  • Maternal infection at risk of maternal-fetal transmission: HIV, HBV, HCV,
Show all 10Show fewer
  • Surgical or anesthetic contraindication.
  • Participation in another interventional research protocol,
  • Patients under legal protection (guardianship, curatorship).
  • Allergies to drugs used in the research

Trial locations and contacts

1 site in 1 country.

France1 site
  • Service médecine foetale-Hôpital Trousseau

    Paris, 75012

Other trials in France

About this study

The purpose of the study is to evaluate the feasibility and the maternal, fetal and postnatal outcomes of sacral myelomeningocele (MMC) and Myelic Limited Dorsal Myeloschisis (MyeLDM) fetoscopic repair at Trousseau Hospital (Paris, France).

Read the detailed description

Myelomeningocele and Myelic limited dorsal myeloschisis (MyeLDM) correspond to neural tube defects which lead to lifelong disabilities including lower extremity paralysis, sphincters deficiency, and cerebral complications (Chiari 2 malformation and hydrocephalus). It is demonstrated that fetal surgery repair of MMC with upper limit between the first thoracic vertebra (T1) and the first sacral vertebra (S1) improves motor and cerebral prognosis. Nowadays, this fetal surgery is performed either after maternal laparotomy and hysterotomy (open fetal surgery) or using fetoscopy. the investigators, at Trousseau Hospital (APHP, Paris), initiated an open fetal surgery of MMC program called PRIUM1 and 16 fetuses has been currently operated.

Fetoscopic repair of MMC is proposed by several international groups in order to prevent from maternal and obstetric morbidity related to the hysterotomy and improve the mother's obstetrical prognosis by allowing vaginal delivery. Results of fetoscopic MMC repair are very satisfying, both in terms of repair surgery efficacy and in terms of obstetrical prognosis. The research team believe that it is justified to propose this minimally invasive repair technique using fetoscopy, for represented by sacral MMC (level S1 and lower) as well as for intermediate forms between open and closed dysgraphisms, represented by MyeLDM. Indeed, these dysraphism are associated with the same cerebral complications than MMC with upper limit between T1 and S1 which could be corrected with prenatal repair. In addition, the spinal cord protection offered by prenatal surgery could prevent from the neuroepithelium destruction observed during pregnancy, with a potential motor benefit for the children.

The main objective of PRIUM 2 is to evaluate the success of fetoscopic surgical repair of sacral MMC or MyeLDM with a birth after 32 weeks of gestation and without severe perinatal morbidity and mortality.

The secondary objectives of PRIUM 2 are to evaluate the complications of pregnancy related to fetoscopic surgery as well as to evaluate the prenatal and postnatal evolution of the cerebral complications (Chiari 2 malformation and hydrocephalus) after fetoscopic repair surgery of the dysraphism (up to 12 months of age).

In this protocol, fetal sacral MMC/ MyeLDM repair surgery will be performed using gas fetoscopy before 26 weeks. After an exteriorization of the uterus through a laparotomy, humidified and warmed gas will be insufflated with low pressure (6 to 8mmHg mmHg). Fetoscopic repair surgery will be performed by a multidisciplinary team (maternal fetal medicine specialists, pediatric neurosurgeons, pediatric surgeons).

After discharge, patients will be followed weekly by a midwife and every two weeks by a referring obstetrician who will perform a clinical examination and a fetal ultrasound.A post procedure MRI will be performed 4 weeks after the surgery. If there is no obstetrical contraindication, vaginal delivery will be authorized.

The children will be followed according to the conventional management of children with dysraphisms and consultations at 8 weeks of life and 12 months of life will be scheduled at Trousseau Hospital, with the multidisciplinary team (pediatric neurosurgeons, physical medicine and rehabilitation specialists, pediatric orthopedic surgeons). During these two consultations, the children will have a complete clinical examination, a cerebral and spinal MRI and an ultrasound of the urinary tract.

Being tested
Fetoscopy
Keywords
Sacral Myelomeningocele, MyeLDM, Fetal surgery, Fetoscopic Repair Program, Neural Tube Defect, Spina bifida
Medical subject headings
Neural Tube Defects, Spinal Dysraphism

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • FetoscopyProcedure or surgery

    After an exteriorization of the uterus through a laparotomy, humidified and warmed gas will be insufflated with low pressure (6 to 8mmHg mmHg). Fetoscopic repair surgery will consist in a dissection of the placode, its reintegration into the spinal canal and the closure of the lesion, through a three ports access. After fetal surgery, the gas will be exsufflated and the trocar ports will be closed. The uterus will be reintegrated before suturing the maternal abdominal wall.

Study groups in NCT04770805
Study groupRoleWhat they receive
Fetoscopic repairExperimentalSacral Myelomeningocele and Mye-LDM Fetoscopic repair
Receives: Procedure: Fetoscopy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Ability to perform fetoscopic sacral MMC/MyeLDM repair without severe perinatal morbidity and mortality

    Successful complete closure of the defect using the fetoscopic technique AND birth after 32 weeks without severe perinatal morbidity and mortality including grade III-IV intra ventricular hemorrhage, severe, cerebral parenchyma hemorrhage, periventricular leukomalacia, grade III ulcero-necrotizing enterocolitis, severe bronchodysplasia)

    Measured: From time of surgery to 8 weeks of life (up to 28 weeks)

Secondary outcomes (22)
  1. Adverse Maternal outcome

    diagnosis of maternal gas embolism, hemorrhage, thromboembolic complication, death

    Measured: during the surgery

  2. Maternal obstetric outcome as evidenced by preterm labor leading to delivery at less than 37 weeks of gestation

    Preterm labor occuring at any time from surgery leading to delivery before 37 weeks of gestation

    Measured: From time of surgery until 37 weeks of gestation

  3. Maternal obstetric outcome as evidenced by preterm premature rupture of membranes

    Preterm premature rupture of membranes occuring at any time from surgery until 37 weeks of gestation

    Measured: From time of surgery until 37 weeks of gestation

  4. Maternal obstetric outcome as evidenced by chorioamnionitis

    chorioamnionitis occuring at any time from surgery until 37 weeks of gestation

    Measured: From time of surgery until 37 weeks of gestation

  5. Maternal obstetric outcome as evidenced by antenatal betamethasone treatment

    indication for a betamethasone course occuring at any time from surgery until 34 weeks of gestation

    Measured: From time of surgery until 34 weeks of gestation

  6. Other Maternal obstetric outcome as evidenced by hypertensive disorders, preeclampsia, gestational diabetes

    hypertensive disorders, preeclampsia, gestational diabetes occuring any time from surgery until 37 weeks of gestation

    Measured: From time of surgery until 37 weeks of gestation

  7. Prenatal evolution of brain abnormalities associated with open dysraphism, after fetoscopic repair

    Difference in the growth of the cephalic perimeter measured on an axial ultrasound section

    Measured: From time of surgery until birth

  8. Prenatal evolution of brain abnormalities associated with open dysraphism, after fetoscopic repair (1)

    Difference in measurement of the ventricles on an axial ultrasound section

    Measured: From time of surgery until birth

  9. Prenatal evolution of brain abnormalities associated with open dysraphism, after fetoscopic repair (2)

    Difference in the measurement of the large retro-cerebellar cistern on an axial section of the posterior fossa

    Measured: From time of surgery until birth

  10. Prenatal evolution of brain abnormalities associated with open dysraphism, after fetoscopic repair (3)

    Proportion of patients with reversal of hindbrain herniation (i.e. lower limit of the vermis located above the foramen magnum on ultrasound and/or fetal MRI)

    Measured: From time of surgery until birth

  11. Maternal obstetric outcome as evidenced by gestational age at delivery (1)

    Gestational age of delivery regardless of indication

    Measured: From time of surgery until delivery

  12. Maternal obstetric outcome as evidenced by gestational age at delivery (2)

    Proportion of deliveries before 37 weeks of gestation

    Measured: From time of surgery until delivery

  13. Maternal obstetric outcome as evidenced by the ability to deliver vaginally

    Mode of delivery - either vaginal or cesarean section

    Measured: From time of surgery until delivery

  14. Proportion of postpartum hemorrhages

    Maternal obstetric outcome as evidenced by postpartum hemorrhage Proportion of postpartum hemorrhages defined by blood loss of more than 500mL for vaginal delivery, and 800mL for cesarean delivery

    Measured: From time of surgery until delivery

  15. Need for maternal transfusion (number of blood cells transfused)

    Maternal obstetric outcome as evidenced by postpartum hemorrhage Need for maternal transfusion (number of blood cells transfused)

    Measured: From time of surgery until delivery

  16. Adverse neonatal outcome at birth (1)

    Normal or abnormal birth parameters at birth depending on the term

    Measured: at birth

  17. Adverse neonatal outcome at birth (2)

    Proportion of fetal asphyxia (arterial pH at the umbilical cord <7.00)

    Measured: at birth

  18. Adverse early childhood outcome as evidenced by need for a neurosurgical intervention

    need for one of the following neurosurgery

    • Type 1: Superficial skin recovery surgery due to scar dehiscence
    • Type 2: Need for surgical correction involving all aspects, without reopening the dura
    • Type 3: Need for complete surgical correction with repair of the dural plane

    Measured: From the time of birth until 8 weeks of life

  19. Postnatal evolution of brain abnormalities associated with open dysraphism

    Difference in the growth of the cephalic perimeter by measuring the cranial perimeter between birth and the age of 12 months

    Measured: From the time of birth until 12 months of life

  20. Postnatal evolution of brain abnormalities associated with open dysraphism (1)

    Difference in the measurement of the cerebral lateral ventricles measured during postnatal transfrontanellar ultrasound followed by cerebral MRI ,

    Measured: From the time of birth until 12 months of life

  21. Postnatal evolution of brain abnormalities associated with open dysraphism (2)

    Proportion of patients with reversal of hindbrain herniation (i.e. lower limit of the vermis located above the foramen magnum on cerebral MRI)

    Measured: From the time of birth until 12 months of life

  22. Postnatal evolution of brain abnormalities associated with open dysraphism (3)

    Proportion of patients requiring a cerebrospinal fluid shunt within the first 12 months of life

    Measured: From the time of birth until 12 months of life

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Feb 2021
  2. Study start16 Apr 2021
  3. Primary completion24 Nov 2024
  4. Study completion8 Dec 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
This is a single arm clinical study. All participants will undergo laparotomy with exteriorization of the uterus followed by fetoscopic repair of the fetal MMC/MyeLDM lesion.
Masking
None (open label)
Enrolment
10 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04770805
Sponsor's protocol ID
APHP191101
Other IDs
N° IDRCB: 2020-A01413-36
Acronym
PRIUM2
Status last verified
Aug 2025
First submitted
24 Jan 2021
Last updated
14 Aug 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Fetoscopy in people with Sacral Myelomeningocele and Neural Tube Defects, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 14 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Ability to perform fetoscopic sacral MMC/MyeLDM repair without severe perinatal morbidity and mortality (time frame: From time of surgery to 8 weeks of life (up to 28 weeks)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Aug 2025.

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