Twin pregnancies are associated with an increased perinatal morbidity and mortality compared with singleton pregnancies, with the risk three to 10 times greater in twins that have a single placenta as compared with two separate placentas.

Successful diagnosis and treatment of fetal complications in twin pregnancies require an experienced team with cutting-edge diagnostic techniques, advanced surgical skill and a comprehensive approach to care.

While the MOMS trial has demonstrated conclusively that open fetal surgery for repair of myelomeningocele improves outcomes, open fetal surgery for MMC is not a cure.

To help prepare the obstetric and neonatal surgery teams for deliveries of high-risk fetuses, the Garbose Family Special Delivery Unit at CHOP has developed a program using simulation, a powerful educational tool that uses manikins to mimic real-life situations.

Abdominal wall defects (AWD) are rare, complex anomalies whose causes are unknown. Optimal outcomes depend on the ability to orchestrate many factors.

The Children's Hospital of Philadelphia has initiated a standard practice of continuous intraoperative echocardiographic monitoring for all fetuses undergoing myelomeningocele repair.

Fetal closure of an MMC is technically more challenging than the standard postnatal closure. The access is smaller, the structures are smaller and more delicate, the placode must be handled with more care, avoiding blood loss is critical, and the surgery must be performed quickly to limit the exposure of the fetus to the extrauterine environment.

Myelomeningocele (MMC) poses a diagnostic and therapeutic challenge. A thorough and detailed examination of the entire fetus, with visualization of every spinal segment, is necessary.

Before the start of the Management of Myelomeningocele Study (MOMS) in 2003, an initial group of 58 patients at CHOP underwent in utero repair of their myelomeningocele between 21 and 25 weeks' gestation. Urologic results after fMMC repair are discussed here.

The CFDT Center at CHOP recently reviewed outcomes for fetal MMC repair since the MOMS results were reported, from referral and evaluation through surgery, delivery and neonatal discharge.