Type of Surgery
Information
Last updated: 11/24/2009
Approximately 3% of babies born in the United States each year have a complex birth defect. Parents are often left with the options of choosing to abort the fetus or treat the condition after birth. Certain birth defects, however, are complicated by...
the labor and delivery process; others may progress quickly after birth to cause significant disability or death. Fetal surgical techniques offer early intervention in order to treat such defects before they become more serious. The first open fetal surgery took place at the University of California at San Francisco (UCSF) in 1981.
Some of the fetal abnormalities that may be treated by fetal surgery are:
- Myelomeningocele. Also called spina bifida, myelomeningocele is a condition in which the spine fails to close properly during early fetal development. The spinal cord may protrude or be exposed through an opening in the lower back. Paralysis, neurological problems, bowel and bladder problems, and hydrocephalus (fluid buildup in the brain) may result. Myelomeningocele affects one out of every 1,000 babies born in the United States.
- Congenital diaphragmatic hernia (CDH). In babies with CDH, the diaphragm (the thin muscle that separates the chest from the abdomen) doesn't develop properly. The abdominal organs may enter the chest cavity through a hole (hernia) and cause pulmonary hyperplasia (underdeveloped lungs). CDH occurs in about one out of every 2,000 births.
- Urinary tract obstruction. The urethra (the tube that carries urine from the bladder to the outside of the body) may become obstructed in utero or fail to develop normally. When this happens, urine can back up into the kidneys and destroy tissue or cause the bladder to become enlarged. The amount of amniotic fluid also decreases because fetal urine is its major component. Pulmonary hypoplasia usually results because the lungs rely on amniotic fluid in their development.
- Congenital cystic adenomatoid malformation of the lung (CCAM). CCAM is a large mass of malformed lung tissue that does not function properly. As a result of its large size, it may put pressure on the heart and lead to heart failure. Lung development is also affected, and pulmonary hyperplasia may result.
- Twin/twin transfusion syndrome (TTTS). In some twin pregnancies, the two fetuses will share a placenta. TTTS occurs in approximately 15% of these twins when blood volume between the fetuses is unequal, causing abnormally low blood volume in the donor twin and abnormally high blood volume in the "recipient" twin. There is often a large difference in size between the twins. Approximately 70–80% of fetuses suffering from TTTS will die without intervention.
- Sacrococcygeal teratoma (SCT). This usually benign fetal tumor develops at the base of the spine (coccyx) and affects approximately one in 35,000 to 40,000 newborns in the United States. The tumor may become very large (sometimes as large as the fetus) and filled with blood vessels, causing stress on the heart.
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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, commonly abbreviated as OB/GYN, can serve as a primary physician and often serve as consultants to other physicians.
From: womenshealthchannel.com
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