Type of Surgery
Information
Last updated: 11/24/2009
What fetal surgical technique is used depends on the specific condition of the fetus and its severity. The fetoscopic temporary tracheal occlusion procedure is used to treat CDH. The trachea is temporarily blocked (occluded) by a small balloon to trap...
fluid in the lungs (that normally escapes into the amniotic fluid); buildup of the fluid enlarges the lungs and stimulates their growth, pushing any abdominal organs that have moved into the chest cavity back into the abdomen. The occlusion is removed immediately after birth of the baby. The procedure is performed endoscopically. Rather than make a large incision into the abdomen and uterus, the surgeon inserts telescopic instruments through a tiny 1 in (2.5 cm) incision and uses them to perform the surgery. Other conditions that are treated with fetoscopic surgery are TTTS (to remove abnormal connections between blood vessels with a laser) and urinary tract obstruction (to insert a wire mesh tube called a stent into the bladder to allow urine to exit the body).
Open fetal surgery is used for conditions that cannot be treated endoscopically. An incision is made through the abdomen and the uterus is partially removed from the body. Amniotic fluid is drained from the uterus and kept in a warmer for replacement after completion of the surgery. An incision is made in the uterus (called a hysterotomy). In order to minimize bleeding of the uterus, an instrument called a uterine stapler is used to make an incision while simultaneously placing staples around the perimeter of the incision to prevent bleeding. Surgery is then performed on the fetus through the opening in the uterus to locate the abnormality and remove or fix it. Open fetal surgery is used for CCAM (to remove the cystic mass), myelomeningocele (to close the exposed spine), and SCT (to remove the tumor). Because of the nature of open fetal surgery, delivery for this child and all subsequent children of this mother will have to be performed by cesarean section.
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Slide show describing the surgeries available to treat fetuses in the womb and some of the problems that can be treated with fetal surgery and heart malformations, neural tube defects, and gastrointestinal tract deformities.
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Other Information
Open fetal surgery is an invasive form of fetal intervention in the treatment of birth defects where the pregnant uterus is opened up for direct surgery on the fetus.
Open fetal surgery is similar in many respects to a normal cesarean section performed under general anesthesia, except that the fetus remains dependent on the placenta and is returned to the uterus. A hysterotomy is performed on the pregnant woman. Once the uterus is open and the fetus is exposed, the fetal surgery begins. Typically, this surgery consists of an interim procedure intended to allow the fetus to remain in utero until it has matured enough to survive delivery and neonatal surgical procedures. Upon completion of the fetal surgery, the fetus is put back inside the uterus and the uterus and abdominal wall are closed up.
The mother remains in the hospital for 3-7 days for monitoring and is required to subsequently deliver the baby via a second cesarean section. Often babies who have been operated on in this manner are born pre-term.
Open fetal surgery has proven to be reasonably safe for the mother. For the fetus, safety and effectiveness are variable, and depend on the specific procedure, the reasons for the procedure, and the gestational age and condition of the fetus.
Other Information
an obstetrician/gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system.
From: womenshealthchannel.com
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