Jeffrey A. Kuller, MD, is the co-author of an ACOG Committee Opinion on Maternal Fetal Surgery for Myelomeningocele. Women with pregnancies complicated by fetal myelomeningocele (a severe form of spina bifida) who meet established criteria for in utero repair should be counseled regarding surgical options, including the possibility of open maternal-fetal surgery for carefully selected patients. However, there is significant maternal risk associated with the surgery including the need for cesarean delivery for the current pregnancy and all future pregnancies and an increased risk of premature delivery.