The CuRe Trial: Cellular Therapy for In Utero Repair of Myelomeningocele

Eligibility for fetal surgery per the MOMS trial, which are:

• Myelomeningocele (including myeloschisis) at any level from T1 through S1 with hindbrain herniation. Lesion level will be confirmed by ultrasound and hindbrain herniation will be confirmed by MRI at the UC Davis Fetal Center
• Maternal age ≥18 years
• Gestational age at enrollment between 19 weeks 0 days and 25 weeks 6 days gestation as determined by clinical information and evaluation of first ultrasound
• Normal karyotype. Results by fluorescence in situ hybridization (FISH) will be acceptable if the patient is greater than 24 weeks gestation;

Not being eligible for fetal surgery per the MOMS trial, which includes:

• Multifetal pregnancy
• Insulin dependent pregestational diabetes
• Fetal anomaly not related to myelomeningocele.
• Kyphosis in the fetus of 30 degrees or more
• Current or planned cerclage or documented history of incompetent cervix, placenta previa or placental abruption
• Short cervix < 20 mm measured by cervical ultrasound
• Obesity as defined by body mass index of 35 or greater
• Previous spontaneous singleton delivery prior to 37 weeks
• Maternal-fetal Rh isoimmunization, Kell sensitization or a history of neonatal alloimmune thrombocytopenia
• Maternal HIV or Hepatitis-B status positive due to the increased risk of transmission to the fetus during maternal-fetal surgery. If the patient's HIV or Hepatitis B status is unknown, the patient must be tested and found to have negative results before she can be enrolled
• Known Hepatitis-C positivity. If the patient's Hepatitis C status is unknown, she does not need to be screened
• Uterine anomaly such as large or multiple fibroids or Müllerian duct abnormality
• Other maternal medical condition which is a contraindication to surgery or general anesthesia. This includes any patient with a previous hysterotomy in the active segment of the uterus (whether from a previous classical cesarean, uterine anomaly such as an arcuate or bicornuate uterus, major myomectomy resection, or previous fetal surgery)
• Patient does not have a support person (e.g., husband, partner, mother)
• Inability to comply with the travel and follow-up requirements of fetal surgery
• Patient does not meet other psychosocial criteria (as determined by the psychosocial interviewer) to handle the implications of fetal surgery
• Participation in another intervention study that influences maternal and fetal morbidity and mortality or participation in this trial in a previous pregnancy;
• Maternal hypertension which would increase the risk of preeclampsia or preterm delivery (including, but not limited to: uncontrolled hypertension, chronic hypertension with end organ damage and new onset hypertension in current pregnancy)
• Active COVID-19 infection at time of fetal surgery as determined by positive test