22 April 2015

Could specialised foetal surgery prevent birth defects?

The uncertain fate of babies diagnosed with serious birth defects could be changed for the better with the help of highly specialised surgery in the safety of their mother’s womb.


Every year, one in every 33 babies born in the US is affected by a birth defect, an abnormality that develops while the baby grows in its mother’s womb, according to the Centres for Disease Control and Prevention. Birth defects can range from mild to severe and cause serious physical and mental disability, or even death.

Thanks to a revolutionary medical procedure called foetal, or prenatal, surgery there’s now new hope for families. Surgeons are able to treat birth defects – including certain heart defects, urinary blockages, bowel obstructions, airway malformations and spinal cord problems – by operating on the foetus in the womb, offering it a chance of an improved quality of life or even being born healthy.

It may sound like science fiction, but the wonder of foetal surgery has been around for more than 30 years. The world’s first human foetal surgery was performed in 1981 by Dr Michael Harrison at the University of California San Francisco (UCSF). The foetus in question suffered from a blockage in the urinary tract that caused the kidney to dangerously extend – a situation that could lead to renal failure. 

Since this pioneering operation, foetal surgery has advanced to include open foetal surgery, fetoscopic surgery and foetal image-guided surgery.

Read: Foetal surgery for babies with spina bifida

Open foetal surgery entails the surgeon making an incision in the mother’s lower abdomen to access the uterus, removing the foetus – partially or fully – from the womb, performing the operation, and then returning it to the womb and closing the incision. The uterus is opened using a special stapling device to prevent bleeding. The Foetal Treatment Centre in San Francisco likens the procedure to a Caesarean section, except that the mother is still pregnant.

Open foetal surgery is a major abdominal operation during which the mother is anaesthetised. It requires hospitalisation for a period of three to seven days. The procedure is risky to both the mother and unborn child as it could lead to preterm labour and delivery, and there’s an increased risk of uterine rupture. Following open foetal surgery, the mother will have to deliver this baby and future pregnancies via Caesarean section.

Because of the risks involved, open foetal surgery is only used for the most severe birth defects such as the treatment of spina bifida (a congenital disorder that occurs when the spinal cord and backbone don’t close properly), the removal of a sacrococcygeal teratoma (a tumour that develops before birth from a baby’s tailbone), the treatment of urinary tract obstruction (a blockage that inhibits the flow of urine through its normal path, which can lead to kidney failure and underdeveloped lungs), and congenital pulmonary airway malformation, a rare abnormality of lung development.

Fetoscopic surgery, developed in the 1990s, is a less invasive procedure using very small endoscopes (thin, flexible telescopes) to access the womb via small incisions in order to see and operate on the foetus. The foetus isn’t removed from the womb – instead, the surgeon operates by guiding very small instruments via direct fetoscopic view on a computer screen. Since this procedure is less invasive, the mother's recovery is easier and there’s a smaller chance of preterm labour.

Fetoscopic surgery (also called fetendo) is used to treat problems with the placenta such as twin-twin transfusion syndrome (a potentially fatal condition in which the blood passes unequally between twin babies while they’re developing in utero), foetal cardiac intervention, bladder and chest shut placement, and intrauterine blood transfusions.

Read: Heart defects in foetuses often undetected

Foetal image-guided surgery is a method of manipulating a foetus without an incision or an endoscopic view inside the womb. Instead, the manipulation is done through the mother's skin or a small incision in her abdomen, under real-time view provided by an ultrasound. Image-guided intervention can be used for amniocentesis (a procedure to diagnose chromosomal abnormalities), placement of catheter-shunts in the bladder, abdomen, or chest, radiofrequency ablation to solve problems with anomalous twins, and some foetal cardiac defects. This is the least invasive intervention and can be performed while a mother is sedated under local anaesthesia. While corrective surgery after birth remains an option for the treatment of many birth defects, an increasing body of medical evidence shows that foetal surgery is more effective in treating certain serious birth defects such as spina bifida, the most common neurological birth defect in the US, affecting 1,500 births each year.

Scientists have discovered that much of the damage caused by spina bifida happens in the womb. According to the findings of an eight-year landmark trial led by researchers at UCSF, babies who undergo corrective surgery for spina bifida while still in the womb have fewer neurological complications such as paralysis and collection of fluid in the brain and, as a consequence, increased mobility, strength and independence.

While surgery to close the spinal column can still be performed just after birth, damage to the nerves may already be firmly established.

Foetal surgery has improved the lives of thousands of children to date, and the development of innovative new surgical techniques combined with stem cell therapy will offer even more possibilities for future generations.

Read: Boost the health of your sperm

Where to get help

Foetal surgery remains a highly specialised surgical procedure and is only performed at a select number of hospitals worldwide. In South Africa, only one doctor, Professor Samad Shaik, is capable of performing such surgeries, according to the Stellenbosch University website. Prof. Shaik is currently the head of the Division of Paediatric Surgery at Stellenbosch University and has performed a number of specialised foetal surgeries in South Africa.

Watch this incredible video clip of foetal surgery, presented by Dr Michael Harrison and the UCSF Fetal Treatment Centre:

Read more:

Painkillers tied to birth defects

Birth defects in multiples on the rise

Birth defects more common in IVF babies

Image: Obstetric Ultrasound of fetus at fourth month from Shutterstock

Sources: The Children's Hospital of Philadelphia; University of California San Francisco; Cincinnati Children's Hospital; Medscape; Sydney Ultrasound for Women; Kid's Health; Benioff Children's Hospital San Francisco; France24; Nature


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