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
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
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
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:
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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