Amnioinfusion by lactated Ringer’s solution via may reduce the toxicity on the exposed nerve tissue in spina bifida

Spina bifida is one of the most common developmental fetal malformations. It is a defect in dorsal spinal elements that exposes nerve tissue to the external environment – the amniotic fluid – leading to toxic exposure. By reviewing the development of fetal therapy, the physiopathology, and the mechanism of spina bifida, we hypothesize that the repetitive early replacement of the amniotic fluid with lactated Ringer’s solution via amnioinfusion may reduce toxicity to the exposed nerve tissue. Studies in fetal rat models suggest that amniotic fluid is toxic to the exposed spinal cord by an inflammatory response. Given the similarity between lactated Ringer’s solution and amniotic fluid, this replacement could mitigate toxicity without altering the intrauterine environment. Randomized controlled trials in animals and human fetuses are needed to test this hypothesis. If effective, this approach could benefit conservative couples and be applicable in low-income settings, improving outcomes after fetal surgery.