Evidence-based medicine and fetal treatment: How to get involved

The Management of Myelomeningocele Study is a multicenter randomized controlled trial of in utero compared with postnatal repair of isolated spina bifida. Referral of potential patients to the Management of Myelomeningocele Study trial will provide the pregnant woman with substantial information about the fetal condition as well as the trial. The referral rate has been very slow. Possible reasons for this are physicians' and the public's belief that in utero surgery has already been proven to be better than postnatal repair or conversely to offer no benefit over standard therapy; that the trial does not address fundamental issues of maternal and fetal outcomes and safety; and that trial is not well designed. These beliefs are ill-founded. The practicing obstetrician has a fundamental role to inform potential patients about this and other research trials.